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t <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 www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 2482 Carpenter Road .4,0 i CITY/ZIP Stockton,95205 m <br /> T D <br /> CROSS STREET Pock Lane APN 179-i'is'tl•i-W-000 PARCEL SIZE 4.76 aC LAND USE APPLICATION# o <br /> A <br /> OWNER NAME Estrella L Jose Famil Limited Partnership(LP Rep=Allan Jose) PHONE 209-598-2584 m <br /> OWNER ADDRESS 2482 Carpenter Road CITY/STATE/LP Stockton,CA 95205 <br /> CONTRACTOR Baja Exploration PHONE 760-715-2566 <br /> CONTRACTOR ADDRESS 246 Vista Grande Glen CITY/STATE/ZIP Escondido/CA/92025 <br /> SUBCONTRACTOR/CONSULTANT Noorzay Geotechnical Services,Inc. PHONE 951-264-9023 <br /> SUBCONTRACTORICONSULTANT ADDRESS 16817 Rainy Vale Avenue CITYISTATE/7JP Riverside,CA 92503 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 604318 EXPIRATION DATE 2/29/2020 <br /> BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:_General Mineral/Coliform Bacteria(4391)- Dibromochloropropane(4392)-Arsenic(4393) <br /> INTENDED USE -Domestic/Private '_Irrigation/Agricultural Industrial -Water Quality Monitoring R Soil Sampling/Characterization <br /> - Public Water System <br /> If dfferent from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK - New Well Replacement Well Well Alteration/Modification ❑Other <br /> Monitoring Wells) #of wells `Soil Borings) #of borings X Geotechnical 3 tt of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal i Cross-Connection Repair <br /> New Pump Pump Replacement _Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary M Auger - Cable Tool i Push Point [I Other <br /> Proposed Well Depth 20-50' ft Excavation 8" in diameter Open Bottom i Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic i Stainless Steel - Other <br /> Grout Seal Depth 20-50' ft �Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) -! Other <br /> Grout Placement Method = Pumped Free Fall 7t Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By -.Driller Pump Contractor _. Other <br /> - Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box -Stove Pipe <br /> PUMP 'Submersible i 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 /> M"MUM¢8 H,()UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED / /!�^.�/1" f�'� TITLE Owner-Baja Exploration DATE 8/12/19 <br /> MENT <br /> FIVE® <br /> 16 2019 <br /> SAll-JOAQUIN COUNTY <br /> FISIVIRONMENTAL <br /> DEPARTMENT <br /> 1144 AR MENT UVE O Lp ^ <br /> Application Accepted ByA&A �V Area Employee ID#� {t9ooJ�l/,�,{ <br /> Grout Inspection By Dale ell Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Check#/ Amount Permit/ <br /> Codes Info B Cash Remitted Date Service Re uest# Invoice# Well ID# <br /> EH043-06 6111=19 WELLIPUMPPERMIT <br />