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WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1668 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 466-3420 <br />NUN-KEFUNDABLE PERMIT CALL (lUV) 95J -1b9/ FOR INSPECTIONS EXPIKES 1 YEAR FROM DATE ISSUE <br />JOB ADDRESS 2615 Station Drive CITYIZIP Stockton/95215 <br />CROSS STREET Duck Creek Dr APN 17334010 PARCEL SIZE 1.52 LAND USE APPLICATION 4 <br />OWNER NAMET&S Intermodal Maintenance Inc. PHONE (916) 416-7781 <br />OWNER ADDRESS P.O. Box 1592 CITY/STATE/ZIP Linden/CA/95236 <br />CONTRACTOR Kleinfelder PHONE. (209) 948-1345 <br />CONTRACTOR ADDRESS 2001 Arch Airport Road, Suite #100 CITYISTATE/ZIP Stockton/ CA/ 95206 <br />SUBCONTRACTOR V&W Drilling PHONE <br />SUBCONTRACTOR ADDRESS 3806 Duck Creek Dr CITY/STATEIZIP Stockton/CA/95215 <br />LICENSE )(C-57 ❑ C-61 ] D-09 ] Other NUMBER 720904 EXPIRATION DATE 04/30/20 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) - Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE ❑ Domestic/Private D Irrigation/Agricultural ❑ Industrial D Water Quality Monitoring XSoil Sampling/Characterization <br />❑ Public Water System <br />R different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK ] New Well ] Replacement Well ] Well Alteration/Modification D Other <br />D Monitoring Well(s) # of wells ] Soil Boring(s) aofbon ngs Geotechnical 5 of borings <br />] Out -Of -Service Well ] Out -Of -Service Well Renewal ] Cross -Connection Repair <br />Drilling Method ] Mud Rotary D Air Rotary Auger ❑ Cable Tool D Push Point ] Other <br />Proposed Well Depth 5-20 ft Excavation 6 in diameter D Open Bottom D Gravel Pack/Gravel Size in ' <br />❑ Conductor Casing in diameter / Conductor Casing Depth ft % <br />Well Casing Diameter —in Thickn s/ auge/ASTM Sched :1Steel Plastic :1Stainless Steel D Other <br />Grout Seal Depth ft Peat Cement (94 lb bag/5-10 gal water) ❑ Sand Cement sack mix/7gal water <br />71 Bentonite (20% solids) :1 Other <br />Grout Placement Method D Pumped ❑ Free Fall Other Tremie Retardant / Accelerator (name) <br />PEDESTAL Installed By -7 Driller ] Pump Contractor -1 Other <br />] Concrete Pedestal ]Dimensions: Width ft Length ft Thick in ] Christy Box ] Stove Pipe <br />PUMP ] Submersible:'? Turbine 71 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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />oy <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />Date <br />Date T,z t <br />❑ WAIVER Received <br />Constructed Well Depth ft <br />�r. <br />EHD43-06 8101/16 C�eW. ter{' 7q,5-QS-L�gD WELL (PUMP PERMR <br />rry COU <br />��pqR 7AL <br />