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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 /> to <br /> JOB ADDRESS 9501 West Lane CITY/ZIP Stockton,CA 95210 y <br /> D <br /> CROSS STREET E.MOrada Lane APN 103 ' r D ARCEL SIZE 4.83 LAND USE APPLICATION# o <br /> z <br /> OWNER NAME City of Stockton Public Works Department-Contact:Antonio Tovar PHONE 209.937.7390 y <br /> OWNER ADDRESS 22 E.Weber Avenue,Room 301 CITY/STATE/ZIP Stockton,CA 95202 `D <br /> _O <br /> CONTRACTOR V&W Drilling,Inc.-Contact:Karli Stroing PHONE Cell:209.981.7755 <br /> m <br /> CONTRACTOR ADDRESS 1 133 Blackhurst Drive CITYISTATEIZIP Galt,CA 95632 <br /> r <br /> d <br /> SUBCONTRACTOR PHONE 7 <br /> SUBCONTRACTOR ADDRESS CITY/STATE/7JP p^ <br /> n <br /> LICENSE X C-57 C-61 D-09 ..Other NUMBER 720904 EXPIRATION DATE 04/30/2020 0 <br /> DOMESTIC WELL SAMPLING:i i General Mineral/Coliform Bacteria(4391) I Dibromochloropropane(4392)u Arsenic(4393) n <br /> D <br /> INTENDED USE - Domestic/Private -1 Irrigation/Agricultural i Industrial 1 Water Quality Monitoring -Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number O <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitonng Well(s) #of wells Soil Bonng(s) #of borings X Geotechnical 4 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal i Cross-Connection Repair <br /> C New Pump i Pump Replacement i Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method F Mud Rotary i Air Rotary X Auger 1 Cable Tool I Push Point 1, Other NeiProposed Well Depth 25 ft Excavation 4 1/2 in diameter Open Bottom i Gravel Pack/Gravel Size in diame C <br /> Conductor Casing in diameter / Conductor Casing Depth ft O e���� <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth full depth ft X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack rdW#al water <br /> Bentonite(20%solids) Other -1/0, <br /> Grout Placement Method Pumped -Free Fall Othe (!Retardant/Accelerator(name) /V Q <br /> PEDESTAL Installed By i Driller i_: Pump Contractor - Other Width F�qUN�, <br /> Concrete Pedestal_'Dimensions: dth ft Length ft Thick in -Christy Box Stove Pipe M 4 <br /> PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level ft �NT <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#ACTIVWITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMON LAWS. <br /> MINIMH V NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLEVice President,Engineering Services DATE 12/11/18 <br /> PA 'TMENT US O L <br /> Application Accepted By toArea Employee ID#_� <br /> Grout Inspection By Date PECIAL Well Permit <br /> Pump Inspection By 1I'�' I� Date i WAIVER Received <br /> Soil Boring Inspection By 11/� �lt� Imo( L Date NA/� Constructed Well Depth ft <br /> COMMENTS `T ' <br /> PE SC Received Amount Permit/ <br /> des Info Cash emi ed Date Service Re uest# Invoice# Well ID# <br /> �Uksli� I <br /> EHD 43-06 reed 4/14/16 WELL/PUMP PERMIT <br />