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.W• WELL/PUMP PERMIT SAN rJAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT SUBCONTRACTOR SUBCONTRACTOR ADDRESS LICENSE X C-57 n C-61 UALL (ZU9) 953-7697 FOR INSPECTIONS APN 163-020-41 11 D-09 I Other tXPIKtb 'I YEAR FROM LIATE ISSUED CITY/ZIP Stockton 95206 ARCEL SIZE 4.2 acresLAND USE APPLICATION # PHONE 925 278-8688 CITY/STATE/ZIP Houston/TX/77046 PHONE 925 313-5800 CITY/STATE/ZIP Martinez/CA/94553 CITY/STATE/ZIP NUMBER C-57 485165 PHONE EXPIRATION DATE 1/31/2020 GEOGRAPHICAL INFORMATION: Coordinates X -121.316092 Y 37.930542 Township Range Section NTENDED USE 11 Domestic/Private ❑ Irrigation/Agricultural I_: Industrial a Water Quality Monitoring X Soil Sampling/Characterization 1-1 Public Water System If different from Owner: Water ys em Name on ac ame or one umber TYPE OF WORK I New Well a Replacement Well I I Well Alteration/Modification ❑ Other I 1 Monitoring Well(s) # of wells L I Soil Boring(s) # of borings IX Geotechnical 8 # of borings n Out -Of -Service Well I I Out -Of -Service Well Renewal I I Cross -Connection Repair I I New Pump ❑ Pump Replacement I I Pump Repair I I Raise Well Casing WELL CONSTRUCTION Drilling Method I Mud Rotary 0 Air Rotary I Auger I I Cable Tool _i Push Point X Other Hammer Driven Proposed Well Depth 20 ft Excavation 2.25 in diameter, Open Bottom I I Gravel Pack/Gravel Size in diameter I Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter 2.25 in Thickness/Gauge/ASTM Sched ❑ Steel I i Plastic I Stainless Steel X Other Temporary Boring Grout Seal Depth 20 ft XI Neat Cement (94 Ib bag/5-10 gal water) (I Sand Cement sack mix/7 gal water I I Bentonite (20% solids) 11 Other Grout Placement Method G Pumped ❑ Free Fall XI Other Tremie Pipe F1 Retardant / Accelerator (name) PEDESTAL NA Installed By F1 Driller 11 Pump Contractor CI Other I I Concrete Pedestal I (Dimensions: Width ft Length ft Thick in I -I Christy Box I_i Stove Pipe PUMP NA I i Submersiblel I Turbine I I Other HP Pump Set ft Standing Water Level ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED Z (Ronald Gestler) TITLE Senior Consultant DATE February 1, 2018 �Appiication Accepted By _ Grout Inspection By _ SC Pump Inspection By _ Soil Boring Inspection By _ COMMENTS P -1 -21 DEPARTMENT USE 9NLY Date Date Date Date 737— A% ��— Area 1, J�LLZAIJ Employee ID# W ❑ SPECIAL Well Permit ❑ WAIVER Received Constructed Well Depth n ft l - , . , _ T M D 0 0 M m -VP / PE Codes 1904 West Charter Way JOB ADDRESS C CROSS STREET Tillie Lewis Drive OWNER NAME Glenn Springs Holdings, Inc. OWNER ADDRESS 5 Greenway Plaza, Suite 110 CONTRACTOR Gregg Drilling & Testing, Inc. CONTRACTOR ADDRESS 950 Howe Road SUBCONTRACTOR SUBCONTRACTOR ADDRESS LICENSE X C-57 n C-61 UALL (ZU9) 953-7697 FOR INSPECTIONS APN 163-020-41 11 D-09 I Other tXPIKtb 'I YEAR FROM LIATE ISSUED CITY/ZIP Stockton 95206 ARCEL SIZE 4.2 acresLAND USE APPLICATION # PHONE 925 278-8688 CITY/STATE/ZIP Houston/TX/77046 PHONE 925 313-5800 CITY/STATE/ZIP Martinez/CA/94553 CITY/STATE/ZIP NUMBER C-57 485165 PHONE EXPIRATION DATE 1/31/2020 GEOGRAPHICAL INFORMATION: Coordinates X -121.316092 Y 37.930542 Township Range Section NTENDED USE 11 Domestic/Private ❑ Irrigation/Agricultural I_: Industrial a Water Quality Monitoring X Soil Sampling/Characterization 1-1 Public Water System If different from Owner: Water ys em Name on ac ame or one umber TYPE OF WORK I New Well a Replacement Well I I Well Alteration/Modification ❑ Other I 1 Monitoring Well(s) # of wells L I Soil Boring(s) # of borings IX Geotechnical 8 # of borings n Out -Of -Service Well I I Out -Of -Service Well Renewal I I Cross -Connection Repair I I New Pump ❑ Pump Replacement I I Pump Repair I I Raise Well Casing WELL CONSTRUCTION Drilling Method I Mud Rotary 0 Air Rotary I Auger I I Cable Tool _i Push Point X Other Hammer Driven Proposed Well Depth 20 ft Excavation 2.25 in diameter, Open Bottom I I Gravel Pack/Gravel Size in diameter I Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter 2.25 in Thickness/Gauge/ASTM Sched ❑ Steel I i Plastic I Stainless Steel X Other Temporary Boring Grout Seal Depth 20 ft XI Neat Cement (94 Ib bag/5-10 gal water) (I Sand Cement sack mix/7 gal water I I Bentonite (20% solids) 11 Other Grout Placement Method G Pumped ❑ Free Fall XI Other Tremie Pipe F1 Retardant / Accelerator (name) PEDESTAL NA Installed By F1 Driller 11 Pump Contractor CI Other I I Concrete Pedestal I (Dimensions: Width ft Length ft Thick in I -I Christy Box I_i Stove Pipe PUMP NA I i Submersiblel I Turbine I I Other HP Pump Set ft Standing Water Level ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 SIGNED Z (Ronald Gestler) TITLE Senior Consultant DATE February 1, 2018 �Appiication Accepted By _ Grout Inspection By _ SC Pump Inspection By _ Soil Boring Inspection By _ COMMENTS P -1 -21 DEPARTMENT USE 9NLY Date Date Date Date 737— A% ��— Area 1, J�LLZAIJ Employee ID# W ❑ SPECIAL Well Permit ❑ WAIVER Received Constructed Well Depth n ft l - , . , _ T M D 0 0 M m -VP / PE Codes SC Info ReceivedCheck#/ B C Amount Remitted Date Permit/ Service Request # Invoice # Well ID# EHD 1 z"l� 0��i� WELL /PUMP PERMIT 4/30/1212