Laserfiche WebLink
v ' <br /> 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 6800 EI Dorado Street CITY/ZIP San Joaquin County,CA <br /> CROSS STREET French Camp Road APN Jf io O PARCEL SIZE LAND USE APPLICATION# A <br /> m <br /> OWNER NAME Newport Carriers Inc PHONE 510-779-6644 N <br /> OWNER ADDRESS 26228 Industrial Boulevard 6/STATE/ZIP Hayward,CA 94545 <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/LP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZJP Clovis,California 93612 <br /> LICENSE /C-57 [!C-61 n D-09 ❑Other NUMBER 499506 EXPIRATION DATE 10.31.2018 <br /> DoMEsnc WELL SAMPLING: i General Mineral/Coliform Bacteria(4391)D Dibromochloropropane(4392)I:]Arsenic(4393) <br /> INTENDED USE n Domestic/Private ❑Irrigation/Agricultural D Industrial CI Water Quality Monitoring n Soil Sampling/Characterization <br /> Public Water System <br /> Ir different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK LI New Well D Replacement Well i7 Well Alteration/Modification CI Other <br /> D Monitoring Well(S) #of wells n Soil Boring(s) n of borings -Z Geotechnical 6 a or borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal L,Cross-Connection Repair— Feet) <br /> Ll New Pump L7 Pump Replacement P Pump Repair a Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑Mud Rotary C Air Rotary ./Auger -i Cable Tool I Push Point D Other <br /> Proposed Well Depths 61'3�J It Excavation in diameter L]Open Bottom C Gravel Pack/Gravel Size in diameter <br /> D Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in [Thickness/Gauge/ASTM Sched !'.Steel IL Plastic i I Stainless Steel i;Other <br /> Grout Seal DepthI hV__0 It V,Neat Cement(94 lb bag/5-10 gal water) J Sand Cement sack mixf7 gal water <br /> u Bentonite(20%solids) i I Other <br /> Grout Placement Method D Pumped rI Free Fall Other i I Retardant/Accelerator(name) <br /> PEDESTAL Installed By D Driller C Pump Contractor - Other <br /> u Concrete Pedestal LiDimensions:Width ft Length ft Thick in a Christy BOX Ll Stove Pipe <br /> PUMP r]Submersible0 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 COMPENSATION LAWS. <br /> MINIMUM 48 HOWL ADYAy NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> "�—� Managing Engineer DATE 03/27/2019 <br /> SIGNED TITLE <br /> NT <br /> L 0 <br /> ED <br /> 2019 <br /> COUNN <br /> ENT�- <br /> gRTMENT <br /> PA TMENT U E NLY <br /> Application Accepted By a Date Area Employee ID#?� <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date f] WAIVER Received <br /> 2 <br /> Soil Boring Inspection By Date Z l 1 q Constructed Well Depth It <br /> COMMENTS <br /> PE SC Received Che Amount PerrniV <br /> odes Info ash emitted Date Service Re uest# Invoice# Well ID# <br /> EHD 43-08 revised 4114118 WELL/PUMP PERMIT <br />