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1N =a I1,9-t <br /> cu, - �..od �nihal Sian '1/511 � <br /> WELL/PUMP PERMIT <br /> SANJOAOUIN COum 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 /> JoBApmEu Application 1 of 2: 1181 Zuckerman Rd CRYZP Stockton. CA 95206 g <br /> GROAS STREET Access Road310 <br /> APN 129- ,6'12 PARCELSRE .USEAPPUCATIONS y <br /> OMERNAMEPaqific Gas k Electric n IN Brent Maeda PHONE (925) 328-5637 FL^ <br /> OWNERAOpREsa 6121 Bollinger Canyon Rd mrs.nunp San Ramon, CA 94583/.5-f-- <br /> CONmACTOR American Construction and Supply, Inc PHONE (4151 927-2024 <br /> COw"cmn AOOREns 45 SM Clemente Drive, Suite A-100 CmISTATEZp COYte Madera CA 94925 <br /> SUBCONIRACTOR NIA PHONE <br /> SUBCONRIACTORADDREea ClTY1STATEJZP <br /> LICENSE XC-57 _C-61 ]009 -Omer NUMBER 310599 ExPIMTONDATE 03/31/2019 <br /> GEOORAPHICALINFORMATON: COa(ElnateSX 37.988229 Y--121-479492 Township Q2N Ranpa 04E Sszeon 2a <br /> INTENOEDU¢E -OonlealYJPrime ]ImgatiOWAg*:,AUm1 _'Industdal -Water Quality MOnilaing D Soil Sampling/Cllamderizatbn <br /> -PubOc Water System <br /> uenemrc awn ov�.,� am m m.m re <br /> TYPEOFWORK XNew Well =Replacement Well ;-Well AlleratioWMmdlceso XOmar Cathodic Protection <br /> Monitoring Weli(s) #01.1s XSoil Borilg(s) a°Ibmrv• -I GetleMniral av11od,,,z <br /> =Out-OfService Well C Out-OI-Servioe Well Renewal D Cmss-Co neclion Repah <br /> - New Pum -PUM Replacement Pump Repair Raise Well Casin <br /> WE CONSTRUCTION <br /> Drilling Method - Mud Rotary -An Rotary X Auger -Cable Tool -Push Point - Other <br /> Proposed Wall Depth 15 R Ex®vation 1_In diameter _Open Bohan - Glavel PaddGmVal Size in diameter <br /> CondUdOr Casing N/A m dier,ow / Corlducw Casing D¢plh fl <br /> Wall Casing Diameter N[A in ThIdma$s/Geuge%STM SChed N/A -Steal D Plastic SUinWss Steel D Omer None <br /> Grout Seal Depth 2 R X Neat Cement(94 It,bagr5-10 g of water) j Sand!Cement sack mlxJ7 gal water <br /> -Bentonite(20%wilds) �Omer <br /> Grout Placement Mamod Pumped XFree Fell ;_Omer _RelantanlIAcoteralor(nams) <br /> PEpESTAL Instilled By X Duller -.Pump Contractor Ogler <br /> COncreN Padeetll-Dimensions:WMlh_fl Length RThidr in XChristy Box Shove Pipe <br /> PUMP _Sulanensmtl[.Turbine ':Omer HP_ Pump Set R Standing Water Level ft <br /> I HEREBY CERTIFY THAT I HAVE PARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCP, STATE LAWS. AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE 15 <br /> CURRENT AND ACTIVE WITIYTIHE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATI.ON`sq <br /> MINIMUM 24 rWu ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIONEO !l/��� Steve McKim m,.E Vice President DATE 04/04/2017 <br /> 1111 H <br /> 71 <br /> GIVEA,J <br /> Q J 201? <br /> RA <br /> U(N COU <br /> MENjAt Ivry <br /> EP RTMENT 9E ONLY <br /> Application Pcceptetl By Data <br /> Areaak!�— Emp"e IDi <br /> UjXX <br /> Gmut Inspec4o Oeta - SPECIAL Well PermR <br /> Pump Inspection By Date _ WAIVER Received <br /> Soil Boring In coon 8 0 le Constructed WeII Dapm It <br /> COMMENTS <br /> PE SC Recelvad Ch.m Amountnal. PertnW InvoieaM WNIIDY <br /> Codes Info B Cash RamRbd Service Ra uaetM <br /> 11 W I dP. I A EWL AE <br /> q. h SROOhl51 <br /> Eno via <br /> wsu mora PERMn <br />