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P✓ <br />X 19406 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205.6232 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />rn <br />JOBADDRESS 2201 W. WASHINGTON ST. Clrr/ZIP STOCKTON 952-3 11 =+ <br />CROSSSTREET AGRI BUSINESS CIRAPNI4 -a D — DI PARCELSIZE 95.91INDUSEAPPLICATION# <br />OWNER NAME PORT OF STOCKTON PHO409-91 5-1805 <br />OWNER ADDRESS P.O. BOX 2089 CITY/STATEIZIP STOCKTON CA 95203 <br />CONTRACTOR _ Delta PttmP-GTc)cTcT0 N ARMATiJRF' & MOTOR WORKS 11"g. 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California Street CITY/STATE/ZIP Stockton, CA 95203 <br />SUBCONTRACTOR PHONE <br />rLI <br />UBCONTRACTOR ADDRESS CITY/STATE/ZIP <br />CENSE 0 C-57 X C-61 0 D-09 0 Other NUMBER 724778 EXPIRATION DATE—08/0 <br />`-1 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Townshin Ranna IZ—fi ., <br />INTENDED USE ❑ Domestic/Private kkigation/Agricultural ❑ Industrial 0 Water Quality Monitoring ❑ Soil Sampling/Characterization y <br />❑ Public Water System <br />If different from Owner: Water ys em` Rame— ont8ct Name or one Number <br />VMM u ivew vveu a Kepiacement well 0 Well Alteration/Modification 0 Other <br />C Monitoring Wells), # of wells D Soil Boring(s) s # of borings u Geotechnical # of Borins s <br />0 Out -Of -Service Well 0 Out -Of -Service Well Renewal 0 Cross -Connection Repair <br />C New Pump 0 Pump Replacement XXump Repair __ ❑ Raise Well Casino <br />Drilling Method 0 Mud Rotary 0 Air Rotary 0 Auger 0 Cable Tool u Push Point ❑ Other <br />Proposed Well Depth ft Excavation in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br />0 Conductor Casing in diameter / Conductor Casing Depth it <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched ❑ Steel 0 Plastic ❑ Stainless Steel ❑ Other <br />Grout Seal Depth ft C Neat Cement (94 lb bag/5-10 gai water) 0 Sand Cement sack mix17 gal water l <br />C Bentonite (20% solids) 0 Other <br />Grout Placement Method 0 Pumped 0 Free Fall ❑ Other 0 Retardant / Accelerator (name) <br />PEDESTAL Installed By 0 Driller 0 Pump Contractor ❑ Other <br />C Concrete Pedestal Dimensions: Width ft Length ft Thick in 0 Christy Box 0 Stove Pipe <br />Pump ubmersible❑ Turbine IS Other HP 1_5_ Pump Seth _ 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. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACT CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />MINII J 11 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED �/ L�� TITLE CEO DATE 5/4/2027 <br />Nar". opt <br />4. i <br />■ i ■ re• <br />PUMP WELL is located approx. <br />142.64 ft. from Port Rd. "G" <br />NOTE: _ <br />r Pl1MP SES- & STAND!N1G V!ATFR LEVCL <br />IS UNKNOWN UNTIL THE JOB IS DONE ,14 <br />M, <br />�v <br />0 <br />X <br />rn <br />4 A*-` <br />HEALTH <br />". 71 <br />0 ?01? <br />co <br />c*r "knr <br />1 '+P <br />EPARTMENT USE ONLY <br />Application Accepted By Date �k/I �— Area Employee ID#-�� <br />Grout Inspection By Date SPECIAL Wel) Permit <br />Pump Inspection By Date 2 Z <br />WAIVER Received <br />Sail Boring Inspection By Date Constructed Well Depth <br />COMMENTS _5:-1 —(7- ia..f�at� �t tf.11C� .� �..;�rftp�•� ,... Q wa{,p- i tl, �r @'_ <br />PEI SC <br />Codes Info <br />M <br />Amount Date Permit/ <br />2emitted Service Request # <br />Invoice # I Well ID# <br />V 900 n,6 <br />EHD 43.06 <br />8/04/08 WELL /PUMP PERMIT <br />