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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 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS F Street South of Mterloo Road CITY/ZIP Stockton,CA <br /> a <br /> CROSS STREET Sierra Lane APNO PARCEL SIZE LAND USE APPLICATION# O <br /> A <br /> to <br /> OWNER NAME PG&E/Brigette Hernandez PHONE 916-244-3269 y <br /> OWNER ADDRESS 6121 Bollinger Canyon Road CITY/STATE/ZIP San Ramon,CA 94583 <br /> CONTRACTOR Cascade Drilling LLP PHONE 916-638-1169 <br /> CONTRACTOR ADDRESS 3000 Duluth Street CITY/STATE/ZIP West Sacramento CA 95691 <br /> SUBCONTRACTOR Barnard Pipeline PHONE 530-669-5910 <br /> SUBCONTRACTOR ADDRESS 21 Pioneer Ave CITY/STATEZP Woodland,CA 95776 <br /> LICENSE x C-57 D C-61 D D-09 D Other NUMBER 938110 EXPIRATION DATE Sept.30th,2019 <br /> DoMEsnc WELL SAMPLING:F1 General Mineral/Coliform Bacteria(4391)-Dibromochloropropane(4392) 1 Arsenic(4393) <br /> INTENDED USE Domestic/Private -Irrigation/Agricultural x Industrial Fi 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 Ll New Well to Replacement Well D Well Alteration/Modification X Other Cathodic Protection Well <br /> U Monitoring Well(s) #of wells U Soil Boring(s) If of borings Geotechnical o of borings <br /> D Out-Of-Service Well D Out-Of-Service Well Renewal D Cross-Connection Repair <br /> D New Pump Pump Replacement D Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method _'Mud Rotary Air Rotary Auger a Cable Tool Push Point 2 Other Sonic <br /> Proposed Well Depth 200' ft Excavation 8" in diameter Open Bottom 9 Gravel Pack/Gravel Size coke Breeze in diameter <br /> I I Conductor Casing N/A in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter 2" in Thickness/Gauge/ASTM Schad 2:SCH 40 Steel X Plastic ❑Stainless Steel D Other <br /> Grout Seal Depth UAW��,t It x Neat Cement(94 Ib bag/5-10 gal water) ❑Sand Cement sack mix17 gal water <br /> Bentonite(2(2T%solids) Other <br /> Grout Placement Method xi Pumped Free Fall X Other PUMPED D Retardant/Accelerator(name) <br /> PEDESTAL Installed By X!Driller Pump Contractor D Other <br /> Concrete Pedestal_Dimensions:Width ft Length ft Thick in D Christy Box Stove Pipe <br /> PUMP Submersible-Turbine D 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 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE V.P Operations DATE 3/20/2019 <br /> Loo <br /> rt <br /> QU/N C <br /> ojjT <br /> 124 112k <br /> EfRTMENT U E 0,14 LY 40 <br /> It q 104 <br /> Application Accepted By ate � Area__L_(� Employee ID# <br /> _jj;jL 4—� <br /> Grout Inspection By Date PECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Dale Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received he Amount Date Permit/ Invoice# Well ID# <br /> Codes I o Remitted i <br /> b <br /> EHD 43-08 revised 4/14110 WELL/PUMP PERMIT <br />