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4 <br /> N, • 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 /> N <br /> JOB ADDRESS 1950 Port Road A(Site:Port Rd.D at Port Rd.7) CITY/ZIP Stockton 95203 <br /> CROSS STREET.See"Job Address"above APN 14502004 PARCEL SIZE 162.3 Acres LAND USE APPLICATION# NA g <br /> m <br /> OWNER NAME Port of Stockton PHONE (209)946-0246 w <br /> OWNER ADDRESS PO Box 2089 CITY/STATE/ZIP Stockton,CA 95201 <br /> CONTRACTOR Taber Drilling PHONE(916)371-8234 <br /> CONTRACTOR ADDRESS 536 Galveston St. CITY/STATE/ZJP West Sacramento,CA 95691 <br /> SUBCONTRACTOR NA PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATEZP <br /> LICENSE K C-57 ❑C-61 D-09 L.A Other NUMBER 969927 EXPIRATION DATE February 29,2020 <br /> DOMESTIC WELL SAMPUNG:❑General Mineral/Coliform Bacteria(4391)-i Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE i Domestic/Private Irrigation/Agricultural ❑Industrial .0 Water Quality Monitoring X Soil Sampling/Characterization <br /> -i Public Water System NA <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK ❑New Well i I Replacement Well ❑Well Alteration/Modification ❑Other <br /> ❑Monitoring Well(s) #of wells a Soil Boring(s) #of borings x Geotechnical 3 #of borings <br /> ❑Out-Of-Service Well ❑Out-Of-Service Well Renewal a Cross-Connection Repair <br /> ❑New Pump a Pump Replacement ❑Pump Repair a Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method is Mud Rotary l Air Rotary a Auger ❑Cable Tool a Push Point r Other <br /> Proposed Well Depth 100 ft Excavation 5 in diameter I Open Bottom ❑Gravel Pack/Gravel Size NA in diameter <br /> i7 Conductor Casing NA in diameter / Conductor Casing Depth NA ft <br /> Well Casing Diameter NA in ThicknesslGaugelASTM Schad NA ❑Steel ❑Plastic ❑Stainless Steel L Other <br /> Grout Seal Depth 100 ft ❑Neat Cement(94 Ib bag/5-10 gal water) ❑Sand Cement sack mix/7 gal water <br /> X Bentonite(20%solids) x Other Geotechnical borings will be backfilled(sealed)with bentonite grout. <br /> Grout Placement Method ❑Pumped a Free Fall X Other Tremie tube L,Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller a Pump Contractor ❑ Other <br /> ❑Concrete Pedestal❑Dimensions:Width ft Length ft Thick in ❑Christy Box C Stove Pipe A <br /> PUMP i Submersible 1 Turbine [i Other HP Pump Set ft Standing Water Level ft A <br /> c MF <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN R� jvr <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 COMPENSATION LAWS. A <br /> MI UM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 a <br /> SIGNED TITLE VP/Exploration Coordinator DATE 02.01.2019IIIIIIIIIIIIIII <br /> N <br /> q4U/ <br /> RpN CpU <br /> See attached geotechnical exploration plan. NSE Nl r' <br /> x464 <br /> 9PA54MENT USJE O N L Y <br /> Application Accepted By_ Date //q Area Employee ID#.1 C 1/ <br /> Grout Inspection By! / Date _ SPECIAL Well Permit <br /> Pump Inspection By Date/�� WAIVER Received <br /> Soil Boring Inspection By DateG-- _-_�� Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info ash Remitted Service Re uest# <br /> a 2 <br /> EHD 43-06 revised 4/14118F73 71Y.7 WELL(PUMP PERMn <br />