Laserfiche WebLink
WELL/PLIMP PERMIT <br /> SAN JOAQUIN COUNTY ENY,RONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)488-3420 <br /> NON-REFUNDABLE PERMIT CA L 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JnS ADDRESS EuckemTan Rd/Neugerbauer Rd Z(Z If %Llerr�f rtk--j CrrY/LP Stockton CA 95208 m <br /> CROSS STREETZUokerman RD I Neugerbauer Ro APN 129 08 009 PARCEL SIZE 565 acreSL_AND USE APPLICATION# I p <br /> OWNER NAME PG&E PHONE 800-7435000 Ii <br /> OWNER ADDRESS 2121 Zuckerman Rd CITYISTATEMP Stockton,CA 95206 <br /> CONTRACTOR Conpro Companies PHONE 510-614-8800 <br /> CONTRACTOR ADDRESS 20991 Cabot Blvd CITYISTATEIZIP Hayward,CA 94545 <br /> SUBCONTRACTOR NONE <br /> PHONE <br /> SUBCONTRACTOR ADDRESS CtrYISTATEIZIP _ <br /> LJCFNsE a C-57 C.C-61 0 D-09 0 Other NumeER 764878 EXPtRATiON DATE 6-30.2019 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391)n Ditxomochloropropane(4392)G Arsenic(4393) <br /> rNTENDED USE 0 m <br /> Doestic/Private 0 Irilgation/Agriculturat 0 Industrial [:Water Quality Monitoring [IS oil Sampling/Characterization <br /> 0 Public Water System <br /> Iodic Protection Hdiftrent"mOwie Water Syslem Name Cordact NaR*or Phone Number <br /> TYPE Or WORT( )1 New Wall n Replacement Wet] 0 Well AReratlon/Modification 0 Other Cathodic Protection 1 Boring <br /> 0 Monitoring Weli(s) #of yells 0 Soil Boring(s) Cor borings 0 Geotechnical R of boning <br /> D Out-Of-Service Well 0 Out-Of-Service Well Renewal 0 Cross-CDnnecticn Repair <br /> 0 New Pump 0 Purrp Replacement G Purnp Repair 0 Raise Well Casing <br /> WELL 11TRiX TION <br /> Drilling Method UXMud Rotary 0 Air Rotary 0 Auger ❑ Cable Tool 0 Push Point 0 Other <br /> Proposed Well Depth 251 It Excavation 10 in diameter C Open Bottom 0 Gravel PacklGravel Size in diameter <br /> 0 Conductor Casing in diameter / Conductor Casing Depth R <br /> Well Casing Diameter_in ThicknesslGauge/ASTM Sched I]Steel 0 Plastic D Sta mess Steel n Other <br /> Grout Seal Depth_ 100 ft .Neat Cement(94 Ib bag15-10 gat water) 0 Sand Cement sack mW7 gal water <br /> C Bentonite(20%sorids) G Other <br /> Grout Placement Method sX Pumped 0 Free Fall U Other G Retardant/Accelerator(name) <br /> PEDESTAL installed By 0 Driller 0 Pump Contractor 0 Other <br /> :]Concrete Pedestal CTD)mensions:Width ft Ler.9th ft Thick ]n 0 Christy Box 0 Stove Pipe <br /> P4Z? G Submersble0 Turbine 0 Other HP Pump Set It Standing Water Level _ ft <br /> I HEREBY CERTIFY THAT 1 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 ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HOUR A41�gh"NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> S,DNEDPaUI Bostwick - e•a,.�°••�`°°�• ' Operations Manager <br /> TITLE DATE <br /> I <br /> ! I I <br /> I I I <br /> I � <br /> I I <br /> ! I <br /> i <br /> PA TMENT U Ego lJ �. <br /> Application Accepted By ! Date Area'^ Employee <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Sol]Baring VV <br /> By Dat <br /> C MM EN TS 'C Q%r( .111�� s v t l n e�r h° C rt�tr stied Well Depth ft <br /> eW <br /> Ou W�( <br /> PE Se Received Checkf4 AmountMSInvolce <br /> Codes Info B h Remitted # We11ID# <br /> tS <br /> EHD43L6 rwes d6rt4jra <br /> WELLFUMP PERMIT <br />