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I WELL/PUMP PERMIT 2428 <br /> SRI JOAOUIN CWNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HA2ELTON AVENUE-SmcxmN CA 95205 .1209)4683420 <br /> NONREFUNDABLE PERMIT CALL(209)_953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> doe.boREea �5261 W. Kingdon Rd. cmmP Lodi/95242 <br /> m <br /> eaa9a$Tm'FT Royal Rd. APN OSS160A9 P IaceL92! LANOUSEAPPUCATmx# <br /> O ssae NAMe lima Ranch-Contact Mike Hamm — Pg1rlCio, T,TGcI4 P.. 209-810-7425 <br /> Owen Antexm 13436 N.TholydOn Rd r cmlSTAri Lodi/95242 <br /> CORMIACmR Delta Pump Inc PHONE 209-466-9625 <br /> coRmAcm.An.. 646 S. Califomla St. cm/STATIEmR Stockton/95203 <br /> SUSEDNITACTOR PHONE <br /> SUBCO CTORAOm S DmISTATFmIP <br /> Leaves GS/ XC-al D-09 (toner NUMBER 1055434 EXPUATION DATE?/31/2D23 <br /> Willi WELL SAMPLING:❑General MinamVColiform Bacteria(4391)D Dibromochlomprepane(4392)0 Arsenic(4393) <br /> INTENDEDUSE XDome650/PrNOB ImgatiaNAgnculluml Industrial Water CUSlity Momomg Soil Sompling/ChamdedmIT. <br /> Public Water System <br /> nmmBremrmm Oxnx wn>SERM.Nmx CEexl Nome«Prore Mlmeer <br /> TYRE OF WORN New Well Replacement Well Wall PHeIagOlVMadMcetlon Other NT <br /> Monitoring WeO(a) #of wells Sail Bonlg(s) Po1eax,N C otechniml #dR*%&ClEF111 r�tD <br /> Out-OlService Well Cul-0ISamce Wall Rerlewal Cress-Conrectbn Repair <br /> NMNE`u.P XPLeapiR.placermant Panp Ru it Raise well Casio J <br /> WEI.1-CONSTRUCTION17 <br /> Drilling Method <br /> Mud Raley Air Rotary Auger Cable Tad Path Point Other SAN,/OA <br /> Preposetl Well Dents ft E.valbtT In Surfacer Open BOfton Gravel PoWiSudval Sire H A NTy. <br /> Contluttm Geeing in tliemeter I Condudar Cesllg Deem IT PAR ENT <br /> Well Casing Diameter_in Tiflickness/GaugWASTUSomal Steal Real. Stainless Steel Olnet <br /> Grout Seal Depth ft Nest Camem f94 Or bsg/610 gal wafts) $and Convent sack Eux7 gal water <br /> Ba ome(20%aclide) Othar <br /> Grant Placement gerund Pumped FTM,Fell Dinner Retardant l ACCNeralor Journal <br /> PsyE�L Installed By Driller Pump Contractor Omar <br /> Cannata Parietal DlmanRkmr Witlth_ft Length ftTMck <br /> m Christy Box Stove Plan <br /> NINE X&IRNEmlNa Turbine Omar HP0.5 Pump Set 42 ft Srnding Water Levd_18_ft <br /> Plot Plan Requirements: Attach a plat plan with the exact location of water well with respect to the following items: GPS <br /> Coordinates, property lines, adjoining properties,water bodies or courses, drainage pattern, roada, existing weUs, structures, <br /> potential sources of contamination,sewers or private disposal systems. Include distance from two property lines. For Domestic, <br /> Agriculture,Industrial well,provide location of any water wells or surface water within 200'radius of proposed well. <br /> MINIMt'NI 24 IKR R ADVANCE NOTICE KEOt11RED FOR INSPECI mNS-PIJ:,\SF.CALL(M)95d 7697 <br /> DEPARTMENT USE ONLY p�,r II �1 <br /> Application Accepted BEla y Date 7 $ Area y I'I Employs.10# /ul/1 <br /> GW Impedion By Date ❑ SPECIAL Wall Permit <br /> PumpinspecUon By �Sr?�rHa Dela I-IZ—Z63 ❑ WAIVER Received <br /> Sail laoring Inspection By Date Constructed Well Depm ft <br /> COnMENT9 �nclIiFIBn [ rChxf, .e wey <br /> 'M -w, 107 Lona'- -/y- 3Sits <br /> ' <br /> PE Sc Racelyed chub Amoum ParmiV <br /> Cods Into By SampR est# hwoicall Wall IDD <br /> 331 0!;0Z 7 <br /> LIIMHIM IMYpiI Ap 1 ef_ sku'Pe Elbma <br />