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• 4DPLICITTON • SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION 445 N SAN JOAQUIN, PHONE (209)468-3420 P 0 BOX 2009, STOCKTON, CA 95201 PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (Complete in Triplicate) Application is hereby made to San Joaquin County for a permit to construct and/or install the work herein described. This application is made in ccmVliance with San Joaquin County Ordinance No. 549 and 1862 and the Rules and Regulations of San Joaquin County Public00 CServices. rte- 9-4 Job Address DR — 600 So Chri qmpnC,ty Trac Lot Size/Acreage 842.58 DDRW-Sharpe Facility, Env. Prot. Office Owners Name Defense Logistics Aeencv Address Roth Rd, Lathrop, CA 95330 Phone (209) 982-2086 McClelland Consultants (West) Contractor FUGRO Geosciences Address 6105 Rookin, Houston, TJ,,e7R7No.C57556015 Phone(713) 778-55M TYPE OF WELL/PUMP: NEW WELL ❑ WELL REPLACEMENT 71 DESTRUCTION ❑ Out of Service Well ❑ PUMP INSTALLATION ❑ SYSTEM REPAIR ❑ 18 CPT OTHER Q Monitoring Well ❑ DISTANCE TO NEAREST: SEPTIC TANK SEWER LINES DISPOSAL FLD. PROP. LINE FOUNDATION AGRICULTURE WELL OTHER WELL PETS/SUMPS INTENDED USE TYPE OF WELL PROBLEM AREA CONSTRUCTION SPECIFICATIONS ❑ industrial ❑ Open Bottom ❑ Manteca Dia. of Well Excavation n Dia. of Well Casing tone i 1 Domesuc/Private ❑ Gravel Pack ❑ Tracy Type of Casing— n one• Specifications N/A I'I Public '11.7 Other FI Delta Depth of Grout Seal tocol depi'h Type of Grout Rea♦•amexf gnat I I hngauon 150' Approx. Depth I I Eastern Surface Soul Installed by Fugro Geosoi.y'6cds Repair Work Done ❑ Type of Pump NA H.P. State Work Done _ Well Destruction ❑ Well Diameter NA Sealing Material 6 Depth Depth Filler Material a Depth TYPE OF SEPTIC WORK: NEW INSTALLATION I 1 REPAIR/ADDITION I I DESTRUCTION I I (No septic system permitted it public sewer is available within 200 feet.l Installation will serve: Residence_ Commercial_ Other Number of living units: _ Number of bedrooms Character of sod to a depth of 3 feet: Water table depth SEPTIC TANK ❑ Type/Mfg Capacity No. Compartments PKG. TREATMENT PLL ❑ Method of Disposal Distance to nearest: Well Foundation Property Line LEACHING LINE ❑ No. 8 Length of lines Total length/size FILTER BED ❑ Distance to nearest: Well Foundation Property Line SEEPAGE PITS 1 1 Depth Size Number SUMPS LI Distance to nearest: Well Foundation Property Line DISPOSAL PONDS ❑ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin county ordinances, state laws, and rules and regulations of the San Joaquin County Home owner or licensed agent's signature certifies the following: "I certify that in the performance of the work for which this permit is issued. I shall not employ any person in such manner as to become subject to workman's compensation laws of California." Contractor's hiring or subcontracting signature certifies the following: "I certify,that in the performance of the work for which this permit is issued,I shall employ persons subject to workman's continents- lion laws of California." The applica/�t mu call=for required inspections. Complete drawing on reverse side. Signed x� vl � Title: NVarogeo�lsi-, eq-&59n Date: 3-Z9-9�} �/�)� �� FOR DEPARTMENT USE ONLY Application Accepted by s'' I ' t"7"sasLC.`Z.f-e� Data Area q'f2 Pit or Grout Inspection by 'tea` L� Date �l///I kFinal Inspection by' '-"� ��r1 Date �d ��' v � Additional Comments. k-ez (,p�'j (Y4 - 'd- /C�1 ^i Applicant - Return all copies to: San Joaquin County Public Health Services Environmental Health Permit/Services (( 445 N San Joaquin, P 0 Box 2009, Stkn, CA 95201 FEE INFO AMOUNT DUE AMOUNT REMITTED CASH RECEIVED BY DATE PERMIT NO, 1H 13*24 IaEv..,.e. 43MY