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9054 INDUSTRUL 64-16 0"t^ <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY 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 /> 'j <br /> p • r0 <br /> IJOB ADDRESS '33280TBLEWETT RD CITY/LP TRACY/95304 g <br /> CROSS STREET SOUTH BIRD RD APN 265-o80-14 PARCEL SIZE X65 LAND USE APPLICATION# <br /> OWNER NAME TEICHERT AGGREGATES ACRES PHONE 916-812-4835 ,9 <br /> OWNER ADDRESS 3500 AMERICAN RIVER DRIVE cmnsTATEmP SACRAMENTOJCA_/95864 <br /> CONTRACTOR EATON DRILLING CO. PHONE 5.,Ao-662-679.5X226 <br /> CONTRACTOR ADDRESS 20 WEST KENTUCKY AVE CITY/STATEmP WOODLAND/CA/95695 <br /> SUBCONTRACTOR NA PHONE NA <br /> SUBCONTRACTOR ADDRESS NA Cm/sTATE/LP NA <br /> LICENSE V C-57 C-61 i D-09 17 Other NUMBER 133783 EXPIRATION DATE 07/31/2016 <br /> GEOGRAPHICAL INFORMATION: Coordinates X 37.61 r -121.353i6 Township_4S Range 6E Seaton 6 <br /> INTENDED U _ Domestic/Private _ Irrigatlon/Agricuftural V Industrial L Water Quality Monitoring _ Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: water SySte.Name arA Name or Phole Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification L Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings Geotechnical #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal i Cross-Connection Repair <br /> J Now Pump i Pump Replacement Pump Repair I Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method VMud Rotary Air Rotary i Auger Cable Tool Push Point d Other REVERSE ROTARY <br /> Proposed Well Depth 1040 ft Excavation _30 in diameter Open Bottom y Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft SRI <br /> #8(8X1/ EL PAC <br /> Well Casing Diameterl . in Thickne s/G>�uge/ASTM Schad SDR 17 J Steel i Plastic L Stainless Steel )/Other PVC <br /> Grout Seal Depth ft Neat Cement(94 Ib bag/5 10 gal water) 11�Sand Cement 10.3 SK sack mixl7 gal water <br /> Bentonite(20%solids);�'Other <br /> Grout Placement Method 1/Pumpea -Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By I_ Driller V Pump Contractor ! Other <br /> Concrete Pedestal 701menslons:Width it Length ft Thick in Christy Box Stove Pipe <br /> PUMP TBA Submersiblel.. Turbine Other HP Pump Set ft Standing Water Level ft 1 <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 /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TON DRILLING CO. TITLE AUTHORIZED AGENT DATE o6/09/2o16 <br /> PAyM <br /> 0 7' <br /> lUly 5?016 <br /> UA, <br /> ;4 - Cr+'ME�N1 Y <br /> �EAgR <br /> �EIVED <br /> SUN 15 2016 <br /> Ell i1v R0NfAENTAI-HEALTH <br /> ERMIT/SEMACES <br /> 11 <br /> DI AR MENT U E NLY <br /> ZA AA �6 V <br /> Application Accepted to �S � Area Employee lD#��' /'�r •.^`� <br /> Grout Inspection By Date 7 ❑ SPECIAL Well Permit <br /> Pump Inspection By '� Date ❑ WAIVER Received <br /> Soil Boring Inspection BYr�����,�� �/� ��� ate Constructed Well Depth __ �7,,��ft /// <br /> COMMENTS4C&T.S � �T /�j`fN l� ��L.t/�/. �� (� / r/ <br /> PE Sved C Receiac Amount Date PeRe Involve• Well ll <br /> Codes Into B Remitted Service Re uest# <br /> s IPn i°� l0171�v S12-bU��vslo W1'�03 3�2 <br /> EHD 43-06 WELL/PUMP PERMIT <br /> 4/30/12 <br />