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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 /> JOB ADDRESS 141 S.Cardinal Avenue CITY/ZJP Stockton,CA m <br /> A/,t <br /> CROSS STREET V V 1�� APN 10- V <br /> Q/PARCEL SIZE O• ✓ LAND USE APPLICATION# A <br /> m <br /> OWNER NAME California Water Service PHONE 408-367-8246 y <br /> OWNER ADDRESS 1720 North First Street CITY/STATE/LP San Jose,CA 95112 <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.3462200 <br /> CONTRACTOR ADDRESS 115 W.Dakota Avenue CITY/STATE/ZIP Clovis,California 93612 <br /> SUBCONTRACTOR Ki azan&Associates,Inc. PHONE 559.346.2200 <br /> SUBCONTRACTOR ADDRESS 215W Dakota AvenUe CITY/STATE/ZIP Clovis,California 93612 <br /> LICENSE JC-57 C-61 I-D-09 I Other NUMBER 49990,". EXPIRATION DATE 10.131.2020 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> ❑Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK •1 New Well Replacement Well ❑Well Alteration/Modification I Other <br /> ❑Monitoring Well(s) #of wells ❑Soil Bonng(s) #of borings f Geotechnical 2 #of borings <br /> 17 Out-Of-Service Well ❑Out-Of-Service Well Renewal ❑Cross-Connection Repair (10-50 Feet) <br /> I New Pump ❑Pump Replacement n Pump Repair ❑Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method i Mud Rotary ❑Air Rotary V Auger I Cable Tool i Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter I Open Bottom Gravel Pack/Gravel Size in diameter <br /> i Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched i Steel a Plastic i Stainless Steel CI Other <br /> Grout Seal Depth ft ;r/Neal Cement(94 Ib bag/5-10 gal wafer) i)Sand Cement sack mix/7 gal water <br /> I I Bentonite(20%solids) I i Other <br /> Grout Placement Method I Pumped I Free Fall I I Other 1 Retardant!Accelerator(name) <br /> PEDESTAL Installed By I i Driller r1 Pump Contractor ':_i Other <br /> I.i Concrete Pedestal I Dimensions:Width It Length ft Thick in I i Christy Box I.I Stove Pipe <br /> PUMP i i Submersible rl 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 /> MINIMUM 48 HOUR VAN E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Managing Engineer DATE 03/08/2019 <br /> 3 2019 <br /> N <br /> Rte,jjN� <br /> ENT <br /> El RTMENT 4SE /ONLY <br /> Application Accepted By Date ;I-It P.1 Area Employee ID# <br /> Grout Inspection By Datea12 I/M SPECIAL Well Permit <br /> Pump Inspection By Dale I WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Chat: Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B as Remitted Se ice Re uest# <br /> EHD 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />