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� APPLICATION EOR WELLIPUMP PERMIT AN JOAQUIN COUNTY PUBLIC HEALTH SERVILW- ENVIRONMENTAL HEALTH DIVISION P.O. BOX 388, 304 EAST WEBER AVENUE, STOCKTON, CA 95201388 (2091468-3420 NONREFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED APPLICATION IB HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCTII ANDIon INSTALL THE WOW DESCRIBED.THIS APPLICATION IS MADE IN COMPLIANCENATIt SAN JOAOUIN COUNTY DEVELOPMENT TRIS,CHAPTER$-1115.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY UBUC HEALTH BERVICEB,ENVIRONMENTAL HEALTH DIVISION. JOB ADDRESSMR APN# 374 Lincoln Center McClellan Wa 1 Settling Dry Cleaning Defen ants s Cm Stockton PARcZ - 0' fest of OWNER'SNAME._CZO nnnala T R ^d h 1 j x- 19 owe treetPNO .- --.-=ece DpgEee-Fmervv-11 f'A GL6nR 1ROO •• CONTRACTOR �"—�+ PHONE#Sl n-FSO-Y•Snn RUB CONTMADDRESS SUBCONTRACTOR..Gregg Drilling & Testing 950 Howe Road UCf PHONE# ADOPES6 '•'+tF18Z, GA ucp CA 48165 PHONE#510-313-5800 TYPE OF WELL/PUMP: ® NFW WELL ❑ REPLACEMENT WELL ® MONITORING WELL# ❑ INSTALLATION ❑ WELL SYSTEM REPAIR ❑ CROSS CONNECT REPAIR ❑ OTHER ❑New❑ ❑ VT WA EXTRACTION N WELL I J RYP OF PIMPI Repelr ILP. DEPTH PUMP 6ET__FT. FIRST WATER LEVEL ❑ OUT OP SERVICE WELL ❑ GEOPHYSICAL WELL# ❑ SOIL BOnING11 O DESTRUCTION: B INfENSED USE TYPE OF WELL CON{TRVCTION{PFCIFICA/10N{ 11 INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVATION I2-inchA 11DOMEBTICR111VATE TGRAVEL PACK/SIZE CIA.OF CONDUCTOR CASING none D TYPEOFCASING/STEEUPVC PVC S steel DIA.OF WELL CASINO 4-inch ❑ UBLIC/MUNICIPAL ❑DnIWNO ❑ IRRIGATION/AO OTHER DEPTU OF GOVT LE 45 feet SPECIFICATION cement-bentonite ❑ R GROUT SEAL INSTALLED BVdr j 7 7 pr GROUT BRAND NAME 9 MONITORING E GROUT BEAL PIMPED: y Ys [IN. CONCRETEPLDESTALBYDRILLETB❑Yr ON. S APPROX.DEPTH $Q feet LOCKING CHESTER BOX/STOVE PPE PROPOSED CON{TRVC"ONG RILUNG METHOD: MUD ROTARYS AIR ROTARY AUGER X 1 monitoringCABLE OTHER_ well - I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE YMP(WILL BE DONE IN ACCORDANCE VAT"BAN JOAOUIN COVNTY ORDINANCES,VAT'LAWS AND RULES AND REGULATIONS OF THE SAN JOAOUIN COUNTY, HOME OWNER OR LICENSED ARENT'S SIGNATURE CERTIFIES THE FOLLOWING: CERTIFY THAI IN THE PERFORMANCE OF THE WON(FOR AND THIS PERMIT 08 ISSUED.I SHALL NOT EMPLOY PERSONS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF CALIFORNIA.' CONTRACTOR'S HIRING OR OUR CONTRACTING SIGNATURE CERTIFjcH IER THE FOLLOWING: -1 CERTIFY THAT IN THE PERFORMANCE Of THE WOPK FOR WHICH THIS PERMIT IS ISSUED,I SHALL EMPLOY PETISONS SUBJECT TO WORKMAN'{COMPENSATION LA OF CAUFO NIA.' THE A_PPPUCANT MUST CALL 24 HOUR{IN ADVANCE FOR ALL REOM OD INSPECTION{AT 121x14UJ 22, COMPLETE DRAWING AT LOWER AREA POVIDED. SlSned�4Y-�-� Ma D.,- PLOT PUN(Or.U,SeNe)Betle -Ip 1. NAMES OF STREETS OR ROADS NEAREST TO OR BOUNDING THE PROPERTY. �. LOCATION OF HOUSE SEWAGE DISPOSAL SYSTEM OR PMlIOSED 2. OUTLINE OF THE PROPERTY,GIVING DIMEN,,,S AND NORTH DIRECTION. EXPANSION F SEWAGE WAGEDISPODI POSTEMB. J. DIMENSIONED OWU FS AND LOCATION OF ALL EXISTING AND PROPOSED STRUCTURES.INCLUDING COVERED AREAS SUCH AS PATIOS,DRIVEWAYS,AND WALK$, S. LOCATION OF WELLS WITHIN RADIUS OF ONE HUNDRED FIFTY FT. ON THE PROPERTY On ADJOINING MKITry. y - � IY OV y e s ><R �e Glt1 w- 3Bp M *SDCDs defined in the First Final Consent Decree 0rde,&AjMjhm&d Referenced to Special Master, filed with the Court on January 18, 1996, Section IV, Paragraph G A,11..11e A.,IW 1-y--)3j—Y'14 yQ/• �JE� bele- _ ! '`✓ ' l Are. GrSVI Imeeellen BY � [ Oeu PMnp lmpaellen By Uete OeeV,cllPn Hmneellpn BY --- Deb Ge,nmre,H Sic /`TL✓'oac-N.y+�ae�t uMt� '�T r-t'� JAI LV ACCOUNTING ONLY: AID# FAC# PE COTE{ FEE INFO /.NONNY REMITTED CHECK#MASH RECEIVED BY DATE PERMIT/{EAMCE nEDUEST NUMBER INVOICE g y.25 12-31 Pub.Health Saw.-Enviro.173(3196)