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W POO 3?3?(9 <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 EAST MAIN STREET - STOCKTON CA 95202 - (209)468-3420 <br />NVIN-KEFUNUAd YtHMII t ALL LUt! `J06-rbtI1 1 -UH INSPEC HUNS CAI'IKLb I YEAR FROM DATE ISSUED <br />JOB ADDRESS 245975400, 6686, & 6701 W. Kite Rd CITY/ZIP Thornton / 95242 <br />CROSS STREET N. Nowell Rd & N. Ray RdC { AIP/NODN`-7F0-OR � 011-190-09 PARCELSIZE 166.6 LAND USE APPLICATION # <br />OWNER NAME 1 , \ Ci CM(A.% I l'J YUF- e J l PHONE !� <br />OWNER ADDRESS TS O I "� K" � e, CITYISTATE/ZIP t CJ `^ r <br />CONTRACTOR Kleinfelder, Inc. PHONE 209-577-4333 <br />CONTRACTOR ADDRESS 1224 6th Street CITYISTATEIZIP Modesto / CA / 95354 <br />SUBCONTRACTOR Tarm-br PHONE 9+E -'17T AZ32r— <br />SUBCONTRACTOR ADDRESSftlgeste�-CITY/STATE/ZIP <br />LICENSE C-57 C-61 D-09 Other NUMBER�7)-r EXPIRATION DATE <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br />INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring czigil Sampling/Characterizabo <br />Public Water System <br />If different from Owner: WaterSystemName Contact Memo or Phone Number <br />TYPE OF WORK New Well Repl ent Well Well Alleration/Modiricatlon Other <br />Monitoring Well(s) # of wells Sol Bodng(s) a of borings Geotechnical /# of bo`t"g' <br />Out -Of -Service We .. Out -Of -Service Well Renewal Cross -Connection Repair <br />Drilling Method 4d Rot Air Rotary u er Cable Tool Push Point Other <br />Proposed Well Depth 30-80 it Excavation 6 In diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth it <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth ft Neat Cement (94 /b bag/5-10 gal water) Sand Cement sack mixl7 gal water <br />Bentonite (20° ' s) Other <br />Grout Placement Method umped Free Fall Other Retardant I Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width it Length ft Thick in Christy Box Stove Pipe <br />PUMP Submersible Turbine 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, SPATE 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 />IMINIM/UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED t-'Y✓i TITLE Project Engineer DATE 10/2/17 <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS _ I- 1 . <br />A E N T U9 O Y <br />1, <br />` I 4 q k <br />Date 1� Area // 1 Employee ID#�J <br />Dale ! D_ ZO 1.� SPECIAL Well Permit <br />Date WAIVER Received <br />Dateonstructed Welllepth ft <br />/I w .._. —.A��- �h//w t _ , <br />PE <br />Codes <br />-�1WVIX37 <br />SC ReceivedChe / <br />Info B sh <br />Am <br />Remitted <br />Permit/ <br />Date Service Re uest# Invoice # Well ID# <br />4 371 <br />15 U (17A <br />4 3q <br />PW3 <br />JOU <br />a <br />irt1� i 3-7 <br />EHO 41-091 <br />A <br />D <br />0 <br />re <br />m <br />N <br />Z <br />Iti Z W <br />UJ <br />o N <br />w o00 <br />ir v <br />r t:J LL. <br />YJd✓t4 TV WELL 1PUMPPERMIT <br />c* 2 b � G A) fJ W"e I I O (W h) <br />