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eC2�EC,7t �J <br /> 18241 WELL/PUMP PERMIT 'A (i <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 952052-(209)468.3420 <br /> iVON-REFUNDABLE PERMIT CALL 209 951-7697 FOR-11481"EGTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> to <br /> JOB ADDRESS 14320 W. SCHULTE RD- CITY21P TRACY 95377 ' <br /> �CROSSSTREET T.AMMF.RS APN209-24-036 PARCEL SIZE52—B,$LAND USE APPLICATION# <br /> OWNER NAME RRT FARMS R,fYt1(. axe - PHONE408 391 8401 <br /> D C c� <br /> OWNER ADDRESS Ogg P AWAY CITYISTATE/ZIP FRFM()NT CJ1 94539 <br /> CONTRACTOR Delta Pulnp_ST0 rXTr1N ARMATIIRF. R MOTOR WORKS 0614111. 209-466-9625 <br /> CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE 0 C-57 X C-61 C D-09 C Other NUMBER 724778 EXPIRATION DATE 08/)L- <br /> GEOGRAPHICAL <br /> 8/)L'GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE 0 Domestic/Private kkigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> 0 Public Water Systelmm�XX <br /> If different from Owner: Water Sysenh Name Con. —.Phone NUMber <br /> TYPE OF WORK ❑New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other <br /> 0 Monitoring Wells) #of wells U Soil Boring(s) S of bwirp 0 Geotechnical W of borings <br /> 0 Out-Of-Service Well 0 Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> 0 New Pump JE)tump Replacement 0 Pump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method D Mud Rotary C Air Rotary ❑Auger 0 Cable Tool 0 Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter 0 Open Bottom D Gravel Pack/Gravel Size in diameter <br /> 0 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_In Thickness/Gauge/ASTM Schad D Steel 0 Plastic 0 Stainless Steel ❑Other <br /> Grout Seal Depth ft C Neat Cement(94 to bag15-10 gel water) 0 Sand Cement sack mix17 gal water <br /> 0 Bentonite(20%solids) C Other <br /> Grout Placement Method 0 Pumped 0 Free Fall 0 Other 0 Retardant/Accelerator(name) <br /> I <br /> PEDESTAL Installed By ❑Driller 0 Pump Contractor 0 Other <br /> 0 Concrete Pedestal Dimensions:Width it Length It Thick in 0 Christy Box 0 Stove Pipe <br /> PUMP 0 Submersible$?)TwDine 0 Other HP Fyp Pump Set It Standing Water Level ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVL WITH THE CALIFORNIA CUNTNACIURS SIArE LICENSE BUARD AND 1HA1 I AM IN COMPLIANCE WI1H ALL , <br /> WORKERS COMPENSATION LAWS. <br /> M NtiUl M 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> SIGNED - TITLE CEO DATE 1/i 1 /7 n 1 i; <br /> OwENSILLIN10i elASS <br /> MFG.ENTRANCE TO THE <br /> VUMP ON EST SIDE OF <br /> PUMP/WEEL IS LOCATED AT THE END OF <br /> THE ROAD,APPROX,OS9 MILES FROM <br /> THE ENTRANCE AT SCHULTE RD. ', , <br /> I I I T - -—I "0', <br /> i <br /> I <br /> n DEPARTMENT USE ONLY <br /> Application Aecepte&.14_ Date ;:2 A,- Employee 104' <br /> Grout Inspection By Date sPEC1AL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring In etion By Date Constructed Well Depth ft <br /> COMMENTS <br /> PESC Received --e Amount Permit' <br /> Codas Info B Date Remitted Service Re uest# Invoice# Well IDA <br /> I <br /> CHO 4306 <br /> &'04/08 WELL/PUMP PERMIT <br />