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IRIELL/PUMP PERMIT <br /> SAN JoACuIN CouNTY ENV*,RONMEKTAL HEAL?H DEPARTUENT 1868 EAST HAZELTON AVENUE-S iDCKTG4 CA 95205-(209)468.3Ml0 <br /> NON-REFUNDABLE PERMIT CALL 2 853-7897 FOR iN3PEGTtoxs EXPIRES 1 YEAR FFtoM DATE ISSUED <br /> jomApppllitl. rnIL <br /> 9053 E ST RT 4 HWY Crr Stockton <br /> Cft= a i s e r RD AP10 3 0 6(10 7 PARCEL Stz!2 8 LAND UM APPLCAT tO <br /> N,,111111111 Paul M Sanguinetti _ Pmw 209-466 0672 <br /> ONMat AmNass 7677 E Hwy 4 CRYISTAWMP S t o c k t o C''\ 95;15 <br /> CONMACMR Purviance Drillers, Inc. 209-887-3554 <br /> P. O. Bcc 64 Innen, <br /> CA 952-35 <br /> CONTRACTOR ADBRM CnYISTATEMP <br /> SuaCONTRACIOR _ PHONL_ <br /> SUBCONTRACTOR ADDRESS CRYISTATEIZIP .__ <br /> U CENSE X C-57 u C•61 n D49 Q Other Nu isER 377923 ExpmAnoN DATE 7/31 /1 5 <br /> GEOGRAPNICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> (H�r>ED UsE G Dom SIPma:e m9 <br /> Iatiom'Agricultural O 01Industrial Water Quality Monitoring n Sol:SamplinglCharacterizalion <br /> 0 PublicYJeter Sys•Lm <br /> (I aMtCCt":rA'T'14'rWam 5yste a.•M v Hwft Nurribw <br /> TYPE OF WOR!( Jew WPJI :;Replacement Well :.1 Well Akctation/Modlfic2tion ❑Other <br /> 0 Mertitoring4Vr!!;si _=of wells "Sail Boring(s) i W Dabtgs U Geotechnical •°t <br /> ❑Out-OfSer;-aV.V:- L Out-01-Service Well Renewal 'u Cross-Connection Repair <br /> ❑New Pump i1 Pump Reotacement Puma Reoair ❑Raise Well Casinq <br /> WELL COUSTRUCTION <br /> Drilling Method a Mud Rolan ❑Air Rotary "Auo— "Cable-,ool ^Push Point D Other <br /> Proposed Wall Deplh-lp® ft Excavation-22 _-_in diameter i Open Bottom 'i Gravel PecidGravelSitter M dlanwAm <br /> ❑Condual—O"asing a.;E _in d ameter / Conductor Casing Depth ft <br /> Wap Casty Diameter/G In Thld :es <br /> uUGaugerASTIA Schad •-15D-_ !Steel ❑Ptssfi43 D Sys Steel ❑ovier <br /> Onxa Seal Depth J 2 O It O Neat Cement(94 Ib bag/S 10 gal water) E Sad Cement !!e S 30a nod?ga*66W <br /> BontorAm a^solids) o Other <br /> Grout Placement Method It Pumped u Foe Fail O Other ❑RelaMar t IAOoslNaOot(name) <br /> SIAL installed By 1910riller U Pump Contrador ❑ Other <br /> Concrete Pedestal nDbnensions Widln ft ft Thi* in ❑Christy Sm ❑Stove Pipe <br /> Pinta Submersible^.Turbine "Olher HP Pump Set ft Standing Water Leve( 11 <br /> t HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQ'UIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AEA IN COMPLIANCE WITH ALL <br /> W01`66iS COTENSAnON LAWS. <br /> MIA h7 24 V NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> sea® i Yu TtT1a Corporate Secreta A� .�r j <br /> PAY/WENT <br /> EI QED <br /> MAY 2 U 2015 <br /> ENO Ap rN couiv . <br /> LTN Df.�RTMNT <br /> DEPARTMENT USE ONLY <br /> AOpftalon Aeoep' By 4 Anr Ol Employee IDO� <br /> t3rertlnped _ <br /> A01ft / 0 SPECIAL Well Permit <br /> Ptalppnpedon DAO ❑ WAIVER Received <br /> Sam SalopDaae Corstructed Well Depth Q <br /> ooMl�►trs.� C�z�t i T6.r�(!.�71�_ Lam/Ze�1 �e r'•r�C?/�Zi_ . <br /> 1pdn W& py h Romidet De` Service Request 4re01eeS W� <br /> J LA X-h S <br /> 804&435 WELL A"...+mrr <br /> .0ou <br />