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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 09 953-7 97 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> Joe ADDRESS Port Rd.D(al Port Rd.7).Port Rd.4(at Port Rd.A).Port d.5(at Port Rd.A) Cm/ZIP Stockton 95203 m <br /> D <br /> CROSS STREET See"Job Address"above APN 14502004 PARCEL SIZE 162 3Acrea LAND USE APPLICATION# NA °o <br /> A <br /> m <br /> OWNER NAME Port of Stockton PHONE (209)946-0246 N <br /> OWNER ADDRESS PO Box 2089 CITY/STATEIZJP Stockton,CA 95201 <br /> CONTRACTOR Gregg Drilling and Testing,Inc. PHONE(925)313-5800 <br /> CONTRACTOR ADDRESS 950 Howe Rd. CITYISTATEIZIP Martinez,CA 94553 <br /> SUBCONTRACTOR NA PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATE/ZIP <br /> LICENSE X C-57 C-61 D-09 .Other NUMBER 485165 ExPIRATION DATE September 2020 <br /> DOMESTIC WELL SAMPLING: -:General Mineral/Coliform Bacteria(4391) _. Dibromochloropropane(4392)-Arsenic(4393) <br /> INTENDED USE _. DomestiGPrivate -Irrigation/Agricultural Industrial Water Quality Monitoring X Soil Sampling/Charactenzalion <br /> Public Water System NA <br /> It tIM.ent ham Owner Water System Name Contact Name or Phone Number <br /> TYPE OF WORK 1 New Well IReplacement Well C Well Alteration/Modification x Other 3 Cone Penetration Tests <br /> O Monitoring Well(s) #of wells C Soil Boring(s) Not borings x Geotechnical 4 M or hodngs <br /> �7 Out-Of-Service Well C Out-Of-Service Well Renewal _ Cross-Connection Repair <br /> New Pump Pump Replacement C Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method x Mud Rotary -Air Rotary - Auger Cable Tool - Push Point X Other Cone Penetration Test(direct push) <br /> Proposed Well Depth 100 ft Excavation 2 to 5 in diameter - Open Bottom -Gravel Pack/Gravel Size NA in diameter <br /> Conductor Casing NA in diameter / Conductor Casing Depth NA ft <br /> Well Casing Diameter NL_in Thickness/Gauge/ASTM Sched NA - Steel _. Plastic -Stainless Steel -Other <br /> Grout Seal Depth 100 9 x Neal Cement(94 lb bag/5-10 gal water) _Sand Cement sack mix/7 gal water <br /> -.Bentonite(20%solids) x Other Geotechnical borings and CPT holes will be backfilled(sealed)with neat cement grout. <br /> Grout Placement Method Pumped Free Fall R Other Tremie tube Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller - Pump Contractor Other <br /> Concrete Pedestal Dimensions.Width ft Length ft Thick in --Christy Box _ Stove Pipe <br /> PUMP -Submersible T Turbine - Other lip Pump Set M Standing Water Level ft <br /> I HEREBY CERTIFY THAT 1 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 /> nUM 48 HOUR_ADaNCE NOTICE REQUIRED FOR INSPEC TIONS-PLEASE CALL(209)953-7697 <br /> SICN. TITLE Associate Geotechnical Engineer DATE January 16,2019 <br /> See attached geotechnical exploration plan. <br /> jqA <br /> X019 <br /> l'C <br /> MFNr <br /> D A M E N T U E 07 L Y <br /> Application Accepted By Dc Area �2- L-rT' <br /> Employee ID# G <br /> Grout Inspection By Dale SPECIAL Well Permit <br /> Pump Inspection By A Dale WAIVER Received <br /> Soil Boring Inspection By Date S ' Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#f Amount tl <br /> Date PermlInvoice# Well ID# <br /> Codes Info ash Remitted Service Re uest# <br /> -HO 434t6 revised 4014/10 WELL IPUMP PERMIT <br />