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• �.ni hal ,Scan, Hl s�l� ff� <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EASTHALELTON AVENUE-$TOCKTON CA 95205.(209(469-3420 <br /> NON-REFUNDABLE PERMIT CALL(2091953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADMEN AOolication 2 of 2: 1181 Zuckerman Rd CITYILP Stockton CA 95206 GGGg <br /> CRoNSTREET AceeBS Road APN 129-031-012 PMICEL SO:E LANo UeE APPUCAmONR <br /> OMUNAMEPac;ifiC GISS & Electric COMPanY.Attilf- Mr. Brent Maeda PNONE (925) 328-5637 <br /> OMMERADDREae 6121 Bollinger Canyon Rdoff&110660 CITY/STATFmp $an Ramon. CA 94583 OIL <br /> CONTwCToot American Construction and Supoly, Inc PHONE (415) 927-2024 <br /> CDNrNkDTOBADMNS 45 Oaf, ClementeD i A-10 CRY/BTATEMP CDYte Madera CA 94925 <br /> SUBCONTRACTOR N/A PNONE <br /> SUBCONTRACTOR ADDRESS CITYISTATEMP <br /> LICENSE XC-57 cCBt =D-09 =Other - NUMBER 310599 Emmmow DATE 03/31/2019 <br /> GEoaRAPTSOALIWOR"MM: CoominatooX 37.988229 Y--121.479492 Te"shlp92N Nange 04E Sargon_Z55 <br /> INTENDED USE -DOGOStlWlivate -Irrigator/Agnulpuml Industrial C Water Quality Monitoring C Sall Sampling/Charac rmarton <br /> Public Water System <br /> nanenMrmu os ac , r — .mR Rr rc „m <br /> TYPE OP WORN XNew Well ]Replacement Well - Wal Newifliond g Von XOtlmr Cathodic Protection <br /> _MOnitodnp We6(a)_sol wets XSoil Bonng(s) aHbO""a° L.GeoteNNral aweonree <br /> =Out-OISaMce Wep -:Ouf-OISeMce Well Renewal Cross-Connection Repair <br /> -New Pum -Pum Re lacement Pum Re ee '-Raise Well Casing <br /> WILLCONSTRUCTON <br /> Drilling Method - MW Rotary - Air Rotary XAuger -'Cable Tod Push Poet Other <br /> Proposed Wall Depth 15 S Excavation 10 in diameter ,OPer BMam -Gravel Peck/Gmvel Size N dims eW <br /> _ Conductor Casing N/A in diameter / Conductor Casing Depth N <br /> Wall Casing Diameter L In Thicknown1aupdASTM SRAM N/A -,Steel n Plaalk _.Stainless Steal it Omer None <br /> Grout Seal Depth 2 B X Neel Cement(94/b bap/540 pal wafer) Sand Cement sack mix/)gel water <br /> - Bemonte(20%sditls) -1 Other <br /> Grout Placement Method C Pumped X Free Feil Other -.Relandanl lACcekratm(rerm) <br /> 011IneYI1M By X Ddter Pump Contractor Dow <br /> Conemt6 Pedestal-Dimensions:Worn —it LengtT N TNtlt_k X Christy Box Stove Pipe <br /> EILMP =SubmersiWeC Turbine _Other HP Pump Sat A Standing Water Level S <br /> 1 HEREBY CERTIFY THAT I HAVE EPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANC -STATE kAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WI 'THE CALJFORN1A CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSAT <br /> MINIMUM-2 ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-7697 <br /> SIGNED Steve McKim TmS vice President DATE 04/04/2017 <br /> Vp <br /> 01? Q �J <br /> EN��gQU/NS ?Q�� <br /> qR MUN ry <br /> DEP RTMENT U E NLY <br /> Application Accepted By Dme Ana Employee I e�"'x�`j�^/'1'''y�m/ Vl�✓/ <br /> Grout Inspecao Date C SPECIAL WBII P8n111LDR <br /> Pump Inspection By Date _ Will Received <br /> Soil Bonny ln99qq��rA0n BY Deft ComWcted Wall Depth R <br /> COMMENTS /'77/ �'/ /7 <br /> PE SC RaceWW Meow Amount Deb Permit/ Invoice of Wap IDN <br /> Into B Cash Rownhted Sarvke Slowestx <br /> 9 5 I ERODhl5 <br /> � 0 <br /> nPn} //9Ls�� WELL HUMP iERMn <br />