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r <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIV ISION <br /> 304 E.WEBER AVE,THIRD FLOOR STOCKTON CA 95202 (209)469-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS 5950 East Woodbridge Road APN <br /> CrrYrzrP Acampo, 95220 PARCEL SIZE �tx rP.0 <br /> OWNER N.AMEWoodbridge Winery ADDRESS P O Box 1?60 <br /> CT alf Woodbridge, 95258 PHONE209-369-5861 ext_2754 <br /> CONTRACTOR`J&W drilling __ ADDRESS P O Box 4i 6 <br /> CrrYrcB' Isleton, 95641 PHONE 916-777-4100 C-57LICENSEN Z2_H.aAEXPDATF-3Q_-0 <br /> j GEOGRAPHICAL INFORMATION: C(X)RDrNATFti X_ Y TOWNSHIP RANGEJ)&SECTION 32- <br /> TYPE OF WELL: (3 NEW WELL ❑ REPLACEMENT WELL SR"" MONrfORWG WELL N /Vl1/)f2 0 OTHER <br /> INSTALLATION: O WELL SYSTEM REPAIR ❑CROSS-CONNECTREPAIR ❑VAPOR EXTRACTION WELL M <br /> TYPE OF PUMP: ❑ NEW O REPAIR H.P. DEPTH PUMP SEf FT. FIRST WATER LEVEL <br /> ❑OUT-OF-SERVICE WELL ❑GEOTP,CHNICAL M ❑SOIL BORING O DESTRUCTION: <br /> INTENDED USE TYPE.OF WEL CONSTRUCTION,SSPEC FICATION <br /> O INDUSTRIAL ❑OPPEN BOTTOM WELL EXCAVATION DIA ~ <br /> � � CONDUCTOR CASING DIA <br /> f3 DOMESTIC PAivATE ®'GRAVEL PACKISIZE*Vj 2. WELL CASING TYPE, r. 4Q (✓WELL CASING Du ?,�'_ <br /> ❑PUBLCIMUNICIPAL 13 DRIVEN 5Q.h GROUT SEAL DEr'ni�— SPECIFICATION <br /> ❑Q2R�ATIONIAG rj� ( OTHER GROUT BRAND NAME <br /> pl(9/ONifORING ``,, GROUT SEAL PUMPED: YES O NO <br /> iTCHRLSTY BOX ❑STOVE PIPE CONCRETE PEDESTAL BY DRILLER: GYS PS L7 NO <br /> APPROXIMATE WELL DEPTH_ <br /> 4�=nC Si1'•�" <br /> PROPOSEDCONSTRUC �If 4ITON/DRQ1.INGMETrUDROTARY AIR ROTARY—AUGER CABLE!OTHER_ <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WTIll SAN <br /> JOAQUIN COUNTY ORDLNANCES,STATE LAWS,AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY C-57 LICENSE IS CURRENT <br /> AND ACTIVE VITfi THE CALIFORNIA CONTRACTOWS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br /> COMPENSATION LAWS. <br /> MI M2 UR ADVANCE NGTICE RE UIRED FOR INSPECTIONS <br /> SIGNED , FC ) iTTLE DATE 2 <br /> I I/4f 14 <br /> IN <br /> ......\.\.....\..\\..\.\..\..\..\..... \N\\\\\ \...... \... <br /> .]..�.j ..\. .} .\...I,\ ... <br /> .. \...�....\�aa>,.\a�\\'t]f�D�xl.�f�AY:et1t:�2,r\ \ :� Y �♦ <br /> IMY• Vii. i/�,,w <br /> i ._ ! \\\\\\\\\�"\\\\\\{rr{ _`1^�,='•, '•MWS,/ <br /> \\\\\\\\\\\\\\\\\\\\\\\\\ <br /> AN V <br /> DEPARTMENT USE ONLY <br /> Atg�� �MPIDN <br /> Application Accepted Y OY <br /> Grout hupection Py Date Pttn,p Inspected By moo?/fol _Dau <br /> Destruction InsT, uan y <br /> COMMENTS:_A/lY <br /> r <br /> P8 SC AMOUNT / RECEIVED DATE k INVOICES WELL IDM <br /> CODES INP) REMITTED CASH BY <br /> s%zoa 8'.601 �3a 33 <br />