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WELL/PUMP PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468.3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> to <br /> Joe ADDRESS Z.kumanRd M<na dtV/ur.wowdnaonlh..V..t,pr....— t hedmaDro..—II...t!aNCITY/ZIP McDonald Island,CA 95206 <br /> D <br /> CROSS STREET Zuckerman Rd APN 12931011 PARCEL SIZE LAND USE APPLICATION# O <br /> A <br /> m <br /> OWNER NAME City of Stockton PHONE a <br /> OWNER ADDRESS City Hall,425N,EI Dorado St CITY/STATE/ZIP Stockton,CA 95202 <br /> Underground Construction Co. 707-741-1761 <br /> CONTRACTOR 8 PHONE <br /> CONTRACTOR ADDRESS 5145 Industrial Way CITY/3TATEIZIP Benlcia,CA 94510 <br /> SUBCONTRACTOR/CONSULTANT Corrpro Companies Inc. PHONE 510-509-4993 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 2625c Barrington Court CITY/STATE/ZIP Hayward,CA 94545 <br /> LICENSE ✓C-57 rl C-61 FI D-09 fl Other NUMBER 764878 EXPIRATION DATE 06/30/2021 <br /> BILLING PARTY: U OWNER U CONTRACTOR ✓SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:U General Mineral/Cofiform Bacteria(4391)U Dibromochloropropane(4392)U Arsenic(4393) <br /> INTENDED USE r Domeslic/Privale I!Irrigation/Agricultural F)Industrial [I Water Quality Monitoring U Soil Sampling/Characterization <br /> Public Water System <br /> If difforent eom Ovmer: Water System Nan. Contact Name or Phone Number <br /> TYPE OF WORK ❑New Well ❑Replacement Well U Well Alteration/Modification Other Cathodic Protection <br /> u Monitoring Well(s) #of wells I I Soil Bodng(s) a orborings r i Geotechnical not bom,gs <br /> IJ Out-Of-Service Well [I Out-Of-Service Wall Renewal -;Cross-Connection Repair <br /> Il New Pum ❑Pump Replacement U Pump Repair ❑Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method VM.d Rotary [i Air Rotary r�Auger U Cable Tool Push Point Other <br /> Proposed Well Depth 300 it Excavation 10"in diameter U Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing In diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickne 'Gauge/ASTM Schee Steel C.Plastic J Stainless Steel ✓Other No Casing <br /> Grout Seal th 100'It y�Neat Cement(94 lb bag/5-10 gat water) F.Sand Cement sack mix/7 gal water <br /> VD <br /> (20%solids) !7 Other Bentonite 100-54'and neat cement 53-3'It <br /> Grout Placement Method n Pumped Free Fall ❑Other c Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller U Pump Contractor U Other <br /> L'Concrete Pedestal fiDimenslons:Width It Length It Thick In U Christy Box -1 Stove Pipe <br /> 'mp C Submersible_Turbine C Other HP Pump Set R Standing Water Level fl <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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED <br /> nzaVIC( oq u!y ign.d by Dawe s.v— TITLE Construction Manager DATE 7/30/2019 <br /> nh-.n.nawd <br /> Ivan <br /> ikc�lj <br /> %A <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee IDN <br /> Grout Inspection By Date U SPECIAL Well Permit <br /> Pump Inspection By Dale I I WAIVER Received <br /> Soil Boring Inspection By Dale Constructed Well Depot It <br /> COMMENTS <br /> PE SC I Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Re uest# <br /> EHO43-M 011112019 wELLIPUMPPERMIT <br /> S <br />