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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 /> to <br /> JOB ADDRESS Thornton&Mosher Slough Pump Station CITY21p Stockton 95209 m <br /> D <br /> CROSS STREET Thornton Rd&Aberdeen Ave. APN 07516001 PARCEL SIZE 0.03 acres LAND USE APPLICATION# o <br /> m <br /> m <br /> OWNER NAME City of Stockton Municipal Utility Dept. Job#M16010 PHONE 209-937-8700 N <br /> OWNER ADDRESS 2500 Navy Drive CITY/STATE/ZJP Stockton CA 95206 <br /> CONTRACTOR Farnest Corrosion Control PHONE 510-952-6256 <br /> CONTRACTOR ADDRESS 2223 Commerce Place CITY/STATE/7jP Hayward CA 94545 <br /> SUBCONTRACTOR n/a PHONE n/a <br /> SUBCONTRACTOR ADDRESS nla CITYISTATE/ZIP nla <br /> LICENSE RIC-57 [:]C-61 [:]D-09 D Other NUMBER 248232 EXPIRATION DATE 12-31-2019 <br /> DOMESTIC WELL SAMPLING:0 General Mineral/Coliform Bacteria(4391)0 Dibromochloropropane(4392)0 Arsenic(4393) <br /> Domestic/Priva <br /> INTENDED USE te gation/Agricultural D ndustrial Water Quality Monitoring D Sail Sampling/Characterization <br /> Public Water Syst07 <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK WiNew Well D Replacement Well D Well Alteration/Modification ✓ Other Cathodic Protection <br /> 0 Monitoring Well(s) #of wells Soi]Boring(s) #ofborings El Geotechnical #ofborings <br /> D Out-Of-Service Well O Out-Of-Service Well Renewal D Cross-Connection Repair <br /> 0 New Pump D Pump Replacement 0 Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ZMud Rotary DAir Rotary o Auger D Cable Tool []Push Point [] Other <br /> Proposed Well Depth 45 ft Excavation in diameter 0 Open Bottom ravel Pack/Gravel Size in diameter <br /> 0 Conductor Casing We in diameter / Conductor Casing De th n/a ft <br /> Well Casing Diameter c in Thickness/Gauge/ASTM Schad PVC Sch 80 Steel D Plastic D Stainless Steel 13ther <br /> Grout Seal Depth !� 1/_fft ✓]Neat Cement(94/b bag/5-10 gal water) o Sand Cement sack mix/7 gal water <br /> D Bentonite;�(200 solids) ❑Other <br /> Grout Placement Methods+ rumped D Free Fall ❑Other Tremmie D Retardant/Accelerator(name) <br /> PEDESTAL Installed By ODdller D Pump Contractor Lyj Other---I <br /> D Concrete Pedestal[]Dimensions:Width ft Length ft Thick in 0 Christy Bax D Stove Pipe <br /> PUMP 0 Submersi4il Turbine 0 Other N/A HP NIA Pump Set NIA ft Standing Water Level wA ft <br /> I HEREBY CERTIFY TH I H VE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY O INAN ES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT D AC WIT THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS OMPE ATION AWS. <br /> M NIM 4 OUR AD A 'E:N TICE REQUIRED FOR IECTIONS PL ASE SAL (209)r-7697 Aj <br /> 7 <br /> SIGNEDA TITLE Il DATE <br /> S E E P L A N S F10 R D E T A I L S <br /> MENT <br /> IVED <br /> 4 2019 <br /> R E# ;1, <br /> N COUNTY <br /> MENTAL I 1 RTMENT <br /> ET M E N T IlISE N L Y <br /> Application Accepted By Date Area Employee ID# <br /> Grout Inspection By Date X SPECIAL Well Permit f eg <br /> Pump Inspection By Date WAIVER Received `•r� <br /> Soil Baring s ec}on By Date Constructed Well Depth ft <br /> CO MENTS (> C J <br /> PE SC Received Check#/ Amount Permit/ <br /> Codes I o 8 Cash emitted Date Service R ,est# Invoice# Well ID# <br /> a I <br /> EHD 43-06 revised 4/14/18 / ._ ^" (/� �// �j WELL/PUMP PERMn <br />