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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT I5Ca 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 30015 Corral Hollow Rd CITY/ZIP Tracy / 95377 m <br /> D <br /> O <br /> CROSSSTREET California Aqueduct // APN 25310015 P PARCEL SIZE 16 LAND USE APPLICATION# __ m <br /> OWNER NAME State Of California / � IpD U(���,Opw��,g 1*kl PHONE <br /> OWNER ADDRESS 1416 9th Street, P.00rr 4:`//��p ��S/C TY/STATE/LP Sacramento, CA — <br /> CONTRACTOR <br /> E7GEO Inc. PHONE 209-684-7611 <br /> CONTRACTOR ADDRESS 17276 Golden Val'iey Pa_'rwa•; CITY/STATE/LP `•athroo / CA ! 95330 <br /> SUBCONTRACTOR Paul Bri-tonjQ� ��/�/J{v�//� PHONE 4C8-355-5781 <br /> SUBCONTRACTOR ADDRESS PO Box 2261 �_�•/fJ~.�I' CRY)STATE/LP Los Gatos. CA 95031 <br /> LICENSE h C-57 C-61 .. D-09 Other NUMBER 849905 EXPIRATION DATE 11/2018 <br /> GEOGRAPHICAL INFORMATION: Coordinate.X Township_ Range Section_ <br /> INTENDED USE Domeslic'Pnvate _ Irngau on Industrial -Water Quality Monitoring x Soil Sam piing/Characterization <br /> Public Water System <br /> If dieerern from Owner wi y -, ame Uordiief Name or ne Nurrbw <br /> TYPE OF WORK New Well - Replacement Well - Well AlteratioNModification Other <br /> Monitorng Well s) #of wells xSoil Bonng(s) 2 0o bo,,g> Geotechnical Mor bonrgs <br /> Out-Of-Service Well Out-Of-Serwce Well Renewal Cross-Connectior Repair <br /> New Pump _ Pump Replacement__Purnp Repair - Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary x Auger Cable Tool Push Point Other <br /> Proposed Well Depth -0-100 ft Excavation r' in d ameter Open Bottom Gravel PackrGravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thick ness!Gauge!ASTM Sched Steel Plastic Stainless Steel - Other <br /> Grout Seal Depth 70-100 It x Neat Cement(941b bag'STO cal water) Sand Cement sack mixl7 gal water <br /> Bentonite(20%solids) 011ier <br /> Grout Placement Method Pumped x Free Fall Otne• Retardant i Accelerator(name) <br /> PEDESTAL Installed By Dreher Pump Contractor Othe- <br /> Concrete Pedestal Dimensions:Width @ Len;tr It 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 COMPENSATION LAWS. <br /> MINIMUM 24 HOUR ANC£NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> �•—_: /'^ (.✓�---_.. prel ect nr3_ncer 3-1F <br /> SIGNED -��� TITLE DATE 4-1 <br /> I QFC �1FNT <br /> 41111 <br /> �6 <br /> /yOFpgR���N�Y <br /> T <br /> t <br /> P­iTMENT US O L <br /> Application Accepted By Date�� / AreaOSPEICq..L .11 <br /> Employee I0#40� <br /> Grout Inspection By Date [2(� /A. C? Permit r <br /> Pump Inspection By _ Date J �+ _- WAIVER Received <br /> Soil Boring In ecllon By_ to Construct d WIII D N Ift <br /> COMMENTS <br /> i <br /> PE SC Received `Check#/ Amoun Permit/ <br /> Date Invoice# Well ID# �/ <br /> Codes Info B Cash Remitted Service Re uest# 7 I <br /> PtorE iS <br /> EH O 13-DD _ WEII PUAW PERMIT <br /> 4/30112 <br />