Laserfiche WebLink
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 Port of Stockton, off of Navy Drive Stockton, 95203 _ m <br /> West Washin ton St 7� 2 n <br /> CROSS STREET g APN 16203007 PARCEL SIZE LAND USE APPLICATION# <br /> OWNER NAME Port of Stockton PHONE (925)328-5311 <br /> OWNERADDRESS 2201 West Washington Street ITYISTATEIZIP Stockton, CA 95203 <br /> CONTRACTOR Klelnfelder Inc. __ _____ PHONE 925 484-1700 <br /> CONTRACTOR ADORESs 6700 Koll Center Parkway CrY/STATE/ZIP Pleasanton, Ca, 94566 <br /> SUBCONTRACTOR Gregg Drilling�g, LL—C., PHONE (925)313-5800 <br /> SUBCONTRACTOR ADDRESS 954 Howe Road CITY/STATEIZIP Martinez CA 94553 <br /> LICENSE ii C-57 C-61 D-09 Other NUMBER 1044456 EXPIRATION DATE <br /> DOMESTIC WELL SAMPLING:: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private I Irrigation/Agricultural Industrial Water Quality Monitoring X Soil Sampling/Characterization <br /> Public Water System <br /> If different from Ovmec Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings k Geotechnical 2 #ofborings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary I Air Rotary Auger Cable Tool Push Point 'x Other CPT <br /> Proposed Well Depth/Ob ft Excavation in diameter 'Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter if Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel . Other <br /> Grout Seal Depth/0 f-> ft X Neat Cement(941b bag15-10 gat water) Sand Cement sack mW7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped ' Free Fall X Other Tremie Retardant/Accelerator(name) <br /> PEDESTAL Installed By . Driller . Pump Contractor Other <br /> L s Concrete Pedestal:.:Dimensions:Width fl Length it Thick in : Christy Box I Stove Pipe <br /> PUMP Submersible. 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. 1 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 CO PENSATION LAWS. <br /> MINI fi1I4 8 OUR VAN NOTICE REQUIRED FOR INSPECTIQNS-PLEASE CALL(209)953-7697 <br /> ` SIGNED TITLE DATE <br /> AI �F.�■ <br /> CeJVp® <br /> -F 04 2019 <br /> NQUIN COU <br /> NTY <br /> EPJ VARONMENT4L <br /> DEPARTMENT <br /> PA TMENT USE 7LY <br /> Application Accepted By V ale f/�// Area_ Employee IDJA <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER ReceiVed <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Cash Remitted Seryice a nest# <br /> 4VZL 1A Ell <br /> EHD43"06 revised 411418CzMf- <br /> WELLIPUMPPERMIT <br />