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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION <br /> 304 E.WEBER AVE., STOCKTON CA 95202 (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOB ADDRESS�Q1_Wf,5t-Twr Iy1Ir Rood rRv <br /> PARCEL SIZE/APN E U— &Y/ZIP L,00_. <br /> OWNER NAME V _ DDNREESS 2D4�-i0I�1I WO�e,,5t �-yJ'-'LSTLVrna I2G <br /> CITY/ZIPr�� " 5 .42- 30 <br /> CONTRACTOK± -6d 0. A dCr,`lDr_) ADDRESS 21 2- r' Lai-v_ <br /> CITY/zIP k 95Z40 PHONE 2;061 - 3(0-+ - 3_- 'Q 1 — <br /> GEOGRAPHICAL INFORMATION: COORDINATES X Y TOWNSHIP RANGE' SECTION l <br /> TYPE OF WELL: ❑ NEW WELL El REPLACEMENT WELL MONITORING WELL# MNL <br /> NL ❑OTHER <br /> INSTALLATION: ❑WELL SYSTEM REPAIR ❑CROSS-CONNECT REPAIR ❑VAPOR EXTRACTION WELL 4 <br /> TYPE OF PUMP: ❑ NEW ❑REPAIR H.P. DEPTH PUMP SET FF. FIRST WATER LEVEL <br /> ❑OUT-OF-SERVICE WELL ❑GEOTECHNICAL# ❑SOIL BORING ❑DESTRUCTION, f <br /> INTENDED USE TYPE OF WELL CONSTRUCTION SPECIFICATION <br /> ❑INDUSTRIAL C OPEN BOTTOM WELL EXCAVATION DIA IT' CONDUCTOR CASING DIA n <br /> ❑DOMESTIC PRIVATE GRAVEL PACK/SIZE WELLCASINGTYJ7,E40 VVC, WELL CASING DIA h <br /> 13PUBLICIMUNICIPAL ❑DRIVEN GROUT SEAL DEPTH +1L. SPECIFICATION <br /> ❑IRRIGATION/AG OTHER GROUT BRAND NAME <br /> )(MONITORING GROUT SEAL PUMPED: ZKYES ❑NO <br /> ❑CHRISTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: Js(YES ❑NO <br /> APPROXIMATE WELL DEPTH - <br /> PROPOSED CONSTRUCTION/DRILLING METHOD: MUD ROTARY ASR ROTARY AUGER C CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICA- ION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY 7CES,STATE LAWS,AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> SIGNED: c ,,� 4, '� /�/� <br /> TITLE:OWN 1L i LS .Xj Ll e_ DATE: 2� �.C�1J7[XV�[/C�f —1"F <br /> " <br /> I <br /> t C+ fr <br /> ir <br /> �t . r ATTACHMFENT C <br /> x 3�)O 59 pf SITE PLAN <br /> 4- <br /> SM JOAQUIN COUNTY <br /> :tz i f SEBASTIAN[ VINEYARD8 <br /> TURNED ROAD VINTNERS <br /> �[I P EAST FACILITY <br /> `7 s••zsa <br /> Apptication Accepted.Ey_ Date 101y&I Are.&LRA.)91C_LJ <br /> Grout Inspection By DatPump Inspected By Date. <br /> Destruction Inspection By Date <br /> COMMENTS: <br /> PE SC AMOUNT CHE # RECEIVED DATE PERMIT/SERVICE REQUEST# WELL ID# <br /> CODES INFO REMITTED CA BY <br /> 2 00 2-0 S- <br />