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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 2111 Quail Lakes Drive _ _ <br />Cm/LP Stockton 95207 <br />CROSS STREET Alexandria Place APN 108-020-04 <br />PARCEL SIZE 6.01 LAND USE APPLICATION # <br />OWNER NAME Stockton Unified School District <br />PHONE 209.933.7045, Ext. 2342 <br />OWNER ADDRESS 1944 North EI Pinal L�� r <br />Cm/STATEmP 95205 s}a, I�Lki, I c <br />CONTRACTOR V & W Drilling - Karli Stroing, President <br />PHONE Cell: 209.981.7755 <br />CONTRACTOR ADDRESS 1133 Blackhurst Drive <br />CITY/STATE21P Galt, CA 95632 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS <br />CRY/STATEMP <br />LICENSE X C-57 C-61 D-09 Other <br />NUMBER 720904 ExPIRAnON DATE 04/30/2020 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township _ Range Section <br />NTENDED USE I Domestic/Private � Irrigation/Agricultural i Industrial 1 1 Water Quality Monitoring Soil Sampling/Characterization <br />I Public Water System <br />Ifdlfferent from Owner. Water em Name Gontad Name or Phone Number <br />TYPE OF WORK 0 New Well F Replacement Well 0 Well Alteration/Modification D Other <br />MonitoringWell(s) #of wells 11 Soil Boring(s) #ofbodrlgs YGeotechnical 8 #oflwringe <br />D Out -0f -Service Well D Out -0f -Service Well Renewal D Cross -Connection Repair <br />D New Pumo 1- Pumo RBnlaCement n Pit— R—ir n Rnicc woe r..i. <br />Drilling Method X Mud Rotary C Air Rotary XAuger - Cable Tool D Push Point . Other <br />Proposed Well Depth 10' t0 50 ft Excavation 4 1/2 in diameter D Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched a Steel u Plastic G Stainless Steel �. Other <br />Grout Seal Depth full depth ft X Neat Cement (94 /b bag/5-10 gal water) ❑ Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) D Other <br />Grout Placement Method D Pumped D Free Fall C Other D Retardant / Accelerator (name) <br />PEDESTAL Installed By D Driller 1 Pump Contractor D Other <br />D Concrete Pedestal i (Dimensions: Width ft Length ft Thick in D Christy Box - Stove Pipe <br />PUMP D SubmersibleD Turbine 1 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 COM"ATION LAWS. <br />MINttT��OTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE Vice President, Engineering Services DATE 07/10/18 <br />R T E N T U S O N Y <br />Application Accepted By a to �� Area Employee ID# V <br />Grout Inspection By- ) yvpl4t� if _ PECIAL Well Permit <br />Pump Inspection By Date -. WAIVER Received <br />Soil Boring Iry9pectioo By Date Constructed Well Depth ft <br />COMMENTS C�Q) rI S lii ✓liTit rn fYp [ �� <br />(/ 13 <br />_N <br />A <br />IENT <br />I ! ED <br />6 2016 <br />IN COUNTY <br />IMENTAL <br />PARTMENT <br />EH D 43-06 WELL /PUMP PERMIT <br />4/30/12 <br />