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+ WELL/PUMP PERMIT P 1--, <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 640 N EI Dorado Street CITY/ZIP Stockton,CA C)�D 20-�— m <br /> D <br /> Park Street 139-060-04 <br /> CROSS STREET APN 1� 1 K PARCEL <br /> `SJIZE V`0 LAND USE APPLICATION# A <br /> OWNER NAME Quick Quack Car Wash �,i`+�i=i-rtr ins C�`VJ�1 tl� lt���'i �q PHONE <br /> ylfi-971-3274 N <br /> CW <br /> OWNER ADDRESS 1380 Lead Hill Boulevard,Suite 260/ �D &l X 3�'1 CITY/STATE/ZIP�sevflle,CA 9 G <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.346.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue. CITY/STATE/ZJP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis.California 93612 <br /> LICENSE VC-57 ,C-61 I D-09 Other NUMBER 499908 ExPIRATION DATE 10.31.2018 ✓ <br /> DOMESTIC WELL SAMPLING:-_General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)�i Arsenic(4393) <br /> INTENDED USE _I Domestic/Private s Irrigation/Agricultural ❑Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> 0 Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK s New Well f l Replacement Well 0 Well Alteration/Modification 1 Other <br /> 0 Monitoring Well(s) #of wells 0 Soil Borings) #of borings f Geotechnical a of borings <br /> ❑Out-Of-Service Well s Out-Of-Service Well Renewal 0 Cross-Connection Repair 5 eet) <br /> 0 New Pum I i Pump Replacement i i Pump Repair J Raise Well CasingPA <br /> WELL CONSTRUCTION Y�� <br /> Drilling Method 0 Mud Rotary fl Air Rotary �Auger s Cable Tool 0 Push Point 0 Other eC NT <br /> Proposed Well Depth(y-49 It Excavation in diameter 0 Open Bottom -i Gravel Pack/Gravel Size in diameter (� 'V�® <br /> 0 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter n Thickness/Gauge/ASTM Schad a Steel Plastic E Stainless Steel 0 Other 0 8 ?018 <br /> Grout Seal Depth 1�i-ri O ft V Neat Cement(94 lb bag/5-10 gal water) 0 Sand Cement sack mix/7 g r <br /> D Bentonite(20%solids) 0 Other AQ(I�N <br /> Grout Placement Method -1 Pumped 0 Free Fall s Other a Retardant/Accelerator(name) L' u <br /> PEDESTAL Installed By 7 Driller 'I Pump Contractor s Other pgRTTAL <br /> Li Concrete Pedestal CDimensions:Width ft Length ft Thick in s Christy Box s Stove Pipe MFNT <br /> PUMP n Submersibles 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, 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 /> 48 AD OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGN <br /> TITLE Managing Engineer DATE 08/28/2018 <br /> FIVE® <br /> 3 0 2018 <br /> ENTAL HEALTH <br /> --4194 IT/SERVICES <br /> PA TMENT US O LYit 11 /(�f� <br /> Application Accepted By ate Areae Employee ID# L <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date 1 WAIVER Received <br /> Soil Boring Inspection Bt n Date L Constructed Well Depth It <br /> COMMENTS <br /> PE SC Received # Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Remitted ery'ceRe st# <br /> EHD43-06 revised 4/14/18 i /39.d(,J WELL/PUMP PERMIT <br /> Viso. 2&-D.0 <br />