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 /> rn <br /> JOB ADDRESS 500 East Louis Avenue cITymp Lathrop / 95330 m <br /> D <br /> CROSS STREET Cambridge Drive APN 198-120-080-000 PARCEL SIZE 117 aC LAND USE APPLICATION# N/A <br /> m <br /> OWNER NAME ASP/RWM Properties,R&B Louise,LLC and R&B Delta,LLC,C/O ECS Corp PHONE Roger Ashton 925-969-9245 y <br /> OWNER ADDRESS 2228 Livingston Street CITY/STATE/ZIP Oakland, CA 94606 <br /> ADA n��n <br /> CONTRACTOR a1L PHONE 925 4-8 4 ZZ7� <br /> CONTRACTOR ADDRESS CITY/STATE/ZIP neet8c <br /> SUBCONTRACTOR Middle Earth Geo Testing PHONE 714-633-5025 <br /> SUBCONTRACTOR ADDRESS 954N. Lemon Street CIT-YL-STATE/ZIP- Orange, CA 92867 <br /> LICENSE XC-57 C-61 D-09 Other NUMB 899451 EXPIRATION DATE 6/30/2019 <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 New Well Replacement Well Well Alteration/Modification X Other Cone Penetration Tests(six) <br /> Monitoring Weil(s) #of wells _.. Soil Boring(s) #of borings _. Geotechnical #of borings <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 Air Rotary Auger Cable Tool Push Point X Other Direct push <br /> Proposed Well Depth 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_ in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth ft X Neat Cement(94 lb bag/5-1 D gal water) Sand Cement sack mix/7 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 /> Concrete Pedestal _Dimensions:Width ft Length ft Thick in _ Christy Box _ 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. 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 COMPEN TION LAWS. <br /> MINIMUM 4 HOU V NCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 4 <br /> SIGNED 44 r rCr%k-TITLE Jr'fi/ !� � Q DATE <br />