Laserfiche WebLink
�/) WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS �` *5 v � ��1-Yy � l. '�IJL � _ CITY/ZIP Tracy, CA 95377 D <br /> CROSS STREET (Z4y �` I LV-4— ij/ CA 2'386002'7 PARCEL SIZE 20'24 LAND USE APPLICATION# m <br /> 7 Cn <br /> OWNER NAME JT Storage (John Toste) PHONE (209) 481-9386 P <br /> OWNER ADDRESS 2460 Toste Drive CITY/STATE/ZIP Tracy CA 95377 <br /> CONTRACTOR RMA Geoscience, Inc. (Consultant) PHONE (559) 708-8865 <br /> CONTRACTOR ADDRESS 3897 N. Ann Avenue CITY/STATE/ZIP Fresno, CA 93727 <br /> SUBCONTRACTOR Exploration Geoservices Inc (Drilling Contractor) PHONE (408) 280-6822 <br /> SUBCONTRACTOR ADDRESS 1535 Industrial Avenue CITY/STATE/ZIP San Jose, CA 95112 <br /> LICENSE X C-57 I I C-61 I I D-09 i I Other NUMBER 484288 EXPIRATION DATE 12-31-15 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring x Soil Sampling/Characterization <br /> Public Water System_ <br /> If different from Owner: Water System Name contact Name or Hhone Number <br /> TYPE OF WORK New Well I Replacement Well I I Well Alteration/Modification I I Other <br /> Monitoring Well(s) #of wells Soil Boring #of borings s) x Geotechnical 2 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal I i Cross-Connection Repair <br /> New Pump I Pump Replacement I Pump Repair I I Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method XL Mud Rotary Air Rotary Auger i 1 Cable Tool Push Point Other <br /> Proposed Well Depth ft Excavation in diameter Open Bottom Gravel Pack/Gravel Size____in diameter <br /> 11 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched 1 1 Steel I Plastic I 1 Stainless Steel Other <br /> Grout Seal Depth See Plan ft 1(Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) (i Other <br /> Grout Placement Method i I Pumped x Free Fall x Other Tremle I 1 Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller I I Pump Contractor I i Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box I I Stove Pipe <br /> PUMP Submersible Turbine I I Other HP Pump Set ft 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 ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> I MUM 2 O DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br /> SIGNS TITLE Staff Engineer(Consultant) DATE 3-11-15 <br /> A <br /> yr u TYE q <br /> T <br /> DEPARTM ENT USE/ ONLY <br /> Application Accepted By � Date Area S r Employee <br /> Grout Inspection By _ Date 1-1 SPECIAL Well Permit <br /> Pump Inspection By _ Date I WAIVER Received <br /> Soil Boring Inspection By s bo Date Constructed Well Depth ft <br /> COMM TS <br /> r /cam <br /> PE SC Received hec Amount Date Permitt Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Request# <br /> k3 4) 15- 3Lfb 7(r <br /> EHD 43-06 WELL/PUMP PERMIT <br /> 4/30/12 <br />