Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
Znihalscan Hight fim <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENMRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-SMCKMN CA 95205•(209)468-1420 <br /> NON-REFUNDABLE PERMIT CALL(2091953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED �^ <br /> JOB ADDRESS Application 2 of 2• 1181 Zuckerman Rd Cm'/LP Stockton 9A 95206 �^ <br /> n <br /> caoss STREET Access Road <br /> Spin 129-031-012 pMCEL SD'E . LAnp USE MPucanONa <br /> OWNERNAMEPaCifiC Gas 5: EleCtriG QQmDAnY.Attn, Mr. Rrtnt Maeda PNaNE (925) 328-5637 <br /> OWNERADDREss 6121 Bollinger Canyon RdASW hood" CQY/$TATEIZIP San Ramon CA 94583 b$. <br /> CONTRACTOR American Construction and Supply, Inc PIroNS (415) 927-2024 <br /> C..cT Aoowa 45 San Clemente Drive Suite A-100 CmbSTATKLm Corte Madera CA 94925 <br /> SUBCONTRACTOR _N/A PHONE <br /> SUBCONTRA TOR ADDRESS pfyl$TATE01, <br /> LICENSE XC-57 ^_C61 JD-09 -Omer NUMBER 310599 EfuomnoNDATE 03/31/2019 <br /> GEODRAPMCALINFORMAMON: Coordlnaiesl( 37.988229 Y -121.479492 Townahlp U2N Range 04E Section,�� <br /> INTENDED USE =OomestlnJPrivate 'InigatlaNAgriaMuml �Indusbiel '_Water Ousay Monitoring -Soil Sampling/Characteruation <br /> rctibliWater System <br /> a111B 0f M Ym <br /> TYPEOFWORK XNew Well -Replacement Well -Wes MeranoNMogmtion <br /> X Other Cathodic Protection <br /> _Monitoring Wen(s)_All X SDil Borings) sw.npa L.Ceatechnieal Tenorno e <br /> -Out-OI-Service Well -Out-01SeMce Well Renewal _CoossConnedion Repair <br /> -Naw Pum -Fume Re IacemeM _Pump Repair Raba Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method -Mud Rotary -Air Rotary X Augur "Cable Tad -'Push Polnl - Other <br /> Proposed Well Depth 15 N E."tim.0 in 6 ernoter :Open Soltom '_Coeval PadF/Grevel Sim in diameter <br /> _CwMNAor Casing N/A indianneter / Conductor Casing Depth A <br /> Wall Casing DiemelerNL in ThickneSM/GeuWASTMStlIed N/A �Steel Plastic Sul Steel ;i DOW None <br /> Grout Seal Depth 2 A X Neal Cement(94 R,Aag'S70 gal water) .. Send Cement sack mix/7 gal waler <br /> BentonRe(20%solids) -,Olhar <br /> Grout Placement Method C Pumped X Free Fall -Other -,Retardant tAccele ssor(name) <br /> PEOEsrnL Ineteliatl By X Driller ;Pump Conbatlor Omar <br /> -Concrete Pa desist DYnanskm:=tc`Or A Lenph flThitic_h1 XCbristy,Box -:S[ove Pipa <br /> PUMP -Submersible[Turbine =Other HP_ Pump Set S Slanding Water Level fl <br /> I HEREBY CERTIFY THAT I HAVE SPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAOUIN COUNTY ORgWr STATE}'AWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTNE WI C RNIA CONTRACTORS STATE LICENSE BOARD AND THAT AM IN COMPLIANCE WITH ALL <br /> WORKERS COD0`IF Al <br /> MINIMUM ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-7697 <br /> SIGNED Steve McKim TITLE Vice President DATE 04/04/2017 <br /> C�4c �� <br /> qpR F® <br /> FNI, gQti/V S? .1 <br /> ITy�Fpj, ,Cou try <br /> AbADjEP RTMENT U E NLY ��� /JApplication Accepted By Gale , Area Employce l <br /> Grout lospecio Dale L'- SPECIAL Well Permit <br /> pump inspection By Dale = WAIVER Received <br /> Soil Boring In ctkn By Data CanaWded Wa110apN R <br /> COMMENTS <br /> PE SC Received ChMMN Amount Dela Permit/ Invdkse Wog IW <br /> Lades Info B Cash RamNted S.mka .este <br /> 7 . 9 5 SR0Uh15 <br /> zYM I 4A— 4717"1 U101-7 <br /> anoa3 0 <br /> rlOn3 I0Q CT/ YAI HUMP PFRYn <br />