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WELL/PUMP PERMIT 120150127.001A <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 EAST MAIN STREET-STOCKTON CA 95202 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> 0 <br /> JOB ADDRESS 8235 W. SCHULTE ROAD Clrr/ZIP Tracy, 95304 m <br /> D <br /> CROSS STREET MacArthur Drive APN 250-180-09 PARCEL SIZE 34.21 ACIeD USE APPLICATION# M <br /> m <br /> OWNER NAME PHONE <br /> OWNER ADDRESS CITY/STATE/ZIP <br /> CONTRACTOR Kleinfelder PHONE 209-948-1345 <br /> CONTRACTOR ADDRESS 2001 Arch Airport Road, Suite 100 CITY/STATE/ZIP Stockton, CA 95206 <br /> SUBCONTRACTOR V&W Drilling PHONE 209-469-7700 <br /> SUBCONTRACTOR ADDRESS 3806 Duck Creek Drive CITY/STATE/ZIP Stockton, CA 95215 <br /> LICENSE XC-57 C-61 D-09 Other NUMBER 720904 EXPIRATION DATE 4/30/2015 <br /> GEOGRAPHICAL INFORMATION: Cp(yFdTat IIITOWrlShlp Range Section <br /> INTENDED USE i Domestic riv a ff 10 /Ag t I I i ater Quality Monitoring X Soil Sampling/Characterization <br /> i i Public Water System <br /> If different frelpa er ys em ame on ac ame or one Number <br /> MnV <br /> TYPE OF WORK New WeIJ�`i, y{ �p c Iltp�i WreJI A tteeratlo odification i Other <br /> Monitoring W�JI s I'1 �tf3"'-h'3o�R➢9t�►1 �Ld #of borings i i Geotechnical R #of borings <br /> Out-Of-S4?41-,IrOnmental 11-1tafthtl) Mien Renewal i-i Cross-Connection Repair <br /> New Pump i Pump Replacement i i Pump Repair i i Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary i Air Rotary XAuger Cable Tool Push Point Other <br /> Proposed Well Depth 15 ft Excavation 6 in diameter =! 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 - Steel i Plastic Stainless Steel Other <br /> Grout Seal Depth 15t ft ycWeat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) XOther�ePoi ��! i Ir �J `^> l w(�✓��Y-+tet <br /> Grout Placement Method Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible 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 /> NIMUM 24 HP7� VANCE NOTICE REQUIRED FOR INSPEYOPI�.'f Ojaej) <br /> SIGNED Saeed Parsa ��- TITLE Pr <br /> fd1 <br /> V� <br /> ho k"A <br /> ' <br /> M. <br /> s7Y•%L 5' � t <br /> IN <br /> DEPART" ENT USE ONLY �-- <br /> Application Accepted By Date ` Area D Employee ID# (q 5` <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS Of a <br /> PE SC Received Check#/ Amount Permit/Codes Info B Cash Remitted, Date Service Request# Invoice# Well ID# <br /> 6%&O 70-'7/ <br /> EHD 43-06 WELL/PUMP PERMIT <br /> 8/04/08 <br />