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1, <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT i www.sjqov.orq/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> 7N <br /> JOB ADDRESS m«arman Rd-AmenildlWurwarklSon theaoa.t.please pee waah.dmap fine. 1—umI CITY/ZIP McDonald Island,CA 95206 pf <br /> CROSS STREET Zuckerman Rd APN 12931011 PARCEL SIZE LAND USE APPLICATION# o <br /> p <br /> OWNER NAME City of Stockton PHONE Nn <br /> OWNER ADDRESS City Hall,425N,EI Dorado St CITY/STATE/ZIP Stockton,CA 95202 <br /> CONTRACTOR Underground Construction Co. PHONE 707-741-1761 <br /> CONTRACTOR ADDRESS 5145 Industrial Way CITYISTATEIZIP Benicia,CA 94510 <br /> SUBCONTRACTORICONSULTANT Corrpro Companies Inc. PHONE 510.509-4993 <br /> SUBCONTRACTORICONSULTANT ADDRESS 2625c Barrington Court CITYISTATEZP Hayward,CA 94545 <br /> LICENSE ✓C-57 C C-61 -1 D-09 Li Other NUMBER 764878 EXPIRATION DATE 06/30/2021 <br /> BILLING PARTY: U OWNER ❑CONTRACTOR VSU8CONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:Cl General Mineral/Coliform Bacteria(4391)__Dibromochloropropane(4392)J Arsenic(4393) <br /> INTENDED USE G DomesticlPrivale, D Irrigation/Agricultural n Industrial Water Quality Monitoring L'Soil Sampling/Characterization <br /> ❑Public Water System <br /> U different from Owner Water Syslem Name C9r0cl N—o ar Ph9na Number <br /> TYPE OF WORK G New Well D Replacement Well L:Well Alteration/Modification Other Cathodic Protection <br /> nMonitoring Well(s) #of wells nSGilBodng(s) Nafbontgs -1 Geotechnical Noftonn9s <br /> Out-Of-Service Well D Out-Of-Service Well Renewal ';Cross-Connection Repair <br /> I1 <br /> NewPump Pump Replacement ❑Pump Repair U Raise Well Casing <br /> WE CONSTRUCTION j <br /> Drilling Method Mud Rotary Air Rotary [I Auger n Cable Toot ii Push Point I_; Other <br /> Proposed Well Depth 300 it Excavation 10"In diameter ::Open Bottom N&avel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness//Gauge/ASTM Schad ❑Steel Plastic LI Stainless Steel Other No Casing <br /> Grout Seal D th 100'ft 1C Neat Cement(941b bag/5-10 gal water) Sand Cement sack man gal water <br /> Venlonite(20%solids) '"Other Bentonite 100-S4'and neat cement 53-3'ft <br /> 1 <br /> Grout Placement Method C;Pumped U Free Fall D Other ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By n Driller Pump Contractor - Other <br /> Concrete Pedestal i:;Dimensions:Width ft Length It Thick In f•:Christy Box !.'Stove Pipe <br /> PUMP i Submersible',,Turbine G Other HP Pump Set R Standing Water Level ft <br /> I HEREBY CER THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUI I COU DINANCES, STATE LA -AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT A ACTT WITH THE CALI NIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS C MP S TION LAWSy <br /> MINI M 4I HO ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Construction Manager DATE 8/5/2019 <br /> PA <br /> eceiv <br /> AUG 0 5 21 <br /> E 19 <br /> JOAQUIN <br /> H IRON cOUN <br /> CTy�FpgR MENS <br /> DEPAR MENT USE ONLY <br /> Application Accepted By n DateArea Employee ID#mr <br /> Grout Inspection By E Date ~U / ❑ SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft Cl'( V <br /> C MMENTS `. <br /> PE SC Received Check#1 Amount Date Permltf Invoice# Well ID# <br /> Codes Info Bv� Cash a Remitted ervlce Re uest# <br /> EHO43-06 6111/2019 WELL RUMP PERMIT <br />