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AI^I^P fW"4 hrA� 11-16 07ll <br /> SQA T -iG 0-o—, <br /> WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1665 EAST HAVELTON AVENUE•STOCKTON CA 9520S.(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953.7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> N <br /> JoBADOREM 17937 C MacArthur Rd CmT21P Tr,cy CA 95377Is <br /> j <br /> CROSS STREET W.Unne Rd. "N 253.15D6BQb PARCELS11E6ALANO USE APPLICATION a <br /> OMERNME Robert Chattier PHONE 510-396.7579 <br /> OWNER ADORER 32932 S.MacArthur Rd. cRYISTATERIp Tracy,CA 95377 <br /> CONTRACTOR PHONE <br /> CONTMCTORADOREae CITYISTATfRIP <br /> SUBCONTRACTOR Martell Water Systems,Inc PHONE 925-4324282 <br /> SUBCONTRACTORAOORESS 18181-OveridgerRd. CITY/STATEZP Pittsburg CA 94565 <br /> LICENSE �/C-57 /C 61 -D-09 -Other 0.21 NUMBER 510952 EXPIRATIONDATE 5131/17 <br /> GEOORAPHCALINFORMIITON: COOrdlnat Y Townshlp_ Range_ SeCUOn� <br /> INIFNe #thus DarnesticJP^vale -IMgaUmlAgricullural -Indusl^al -Wa1er Oweety Mondo^n9 -Sod SamplinglCharaderiiation <br /> utirtalirviomoyn.1em n am emvI.midmeAuluel <br /> rMSOPWORR VNeAl - Repucement Well -Wait AllemtioNModVieal - Other <br /> -Monilonne Well(s)_301xells 5618.nnotsl eolmulNa - Control SMmn� <br /> out01-Service Well " OuHOT-Service Well Renmval -CmM-Connection Repair <br /> VNI.Peras Pump Replacement Pump Repair Raise Well Casino <br /> WELLCONSTRUCTON <br /> Drilling MethotlVMutl Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Wall Depth 700' R Eleavation_in diameter Open Dothum Gravel Pad✓Gnvel Silo in diameter <br /> Condudar Casing_in diameter I Conductor Casing Depth n 3 HP <br /> Well Casing Diamder 5_in ThlrknesslGaugelASTM Schell Certo-loe -Steel 5/Plastic - Stainless Steel "Other <br /> Grout Soal Depth 200' R Neal cement(94111 bag75•Te gal watery VSand Cement 10.3 Sacs, at water <br /> -/Bemonila(20%satds) - Other grout seal pending on E-long and lithology lnding 680r <br /> Grout Placement Method ViPumped -Fore Fall -Other -Relardient/Pccelemlor(navalELU OO <br /> TA insultedConwUP.dMAlr DimanibOa Winam l�a_n Lenher <br /> gthII in X .Stove Pipe 27p <br /> PuuP Submenll Turbine -Other HP 11KN Pump Sel UKN Standing Water OVINyXN- <br /> 1 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CO RACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSA OMIAWS. <br /> MI 1 4 OUR AD NO E REQUI D FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIc�B- / TITLE COO GATE 6/2116 <br /> IAll oc reI t [ <br /> T■ l� <br /> ! a `. <br /> N I/ � Rr'PY' V <br /> `oI <br /> � �it�jJ'_ �� <br /> ..sve.bIJ FNI <br /> 0 AA MENT UEpy LV <br /> Application Accepted le a Mca _ Employ.. our 6GbU�oS <br /> Grout lnspedion By Dale F SPECIAL Well POnnit <br /> Pump Inspection By Date r WAIVER Received <br /> Soil Safina Inspection By Date Constructad Wall Depth <br /> COMMENTS <br /> PE SC Re Im,*d Ch Ile Pmounl DOA Pom1iU Invoice Well ID# <br /> Codas Info B ah llle <br /> Reatl Sorvleoil oast# <br /> t�or x °' 3 sgm-) 9� <br /> a 74>-& 6ROO-1520111, <br /> EMp<3aeWEURulla i=12 <br />