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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 /> 431 Sperry Road Stockton,CA LA <br /> JOB ADDRESS P ry CITU/Z.IP � <br /> CROSS STREET S.McKinley Avenue APN(� t� '3 6 a <br /> PARCEL SIZE LAND USE APPLICATION# a <br /> PHONE <br /> OWNER NAME <br /> Valimet Inc. 209-444-1600 m <br /> OWNER ADDRESS 431 Sperry Road CITY/STATE/ZIP Stockton,CA 95206 <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis.California 93612 <br /> LICENSE -/C-57 D C-61 11 D-09 Il Other NUMBER 499908 EXPIRATION DATE 10.31.2019 <br /> DOMESTIC WELL SAMPLING:n General Mineral/Coliform Bacteria(4391)❑Dibromochloropropane(4392)F,Arsenic(4393) <br /> INTENDED USE 7 Domestic/Private D Irrigation/Agricultural Industrial n Water Quality Monitoring ^Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well I Replacement Well o Well Alteration/Modification U.Other <br /> Monitoring Well(s) #of wells D Soil Boring(s) #of borings Geotechnical 4 #of borings <br /> Out-Of-Service Well D Out-Of-Service Well Renewal I,Cross-Connection Repair (10-50 Feet) <br /> D New Pump r i Pump Replacement -1 Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method D Mud Rotary ❑Air Rotary Auger D Cable Tool D Push Point ❑ Other <br /> Proposed Well Depth ft Excavation in diameter ❑Open Bottom D Gravel Pack/Gravel Size in diameter <br /> D Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched _I Steel D Plastic ,I Stainless Steel a Other <br /> Grout Seal Depth it y Neat Cement(94 Ib bag/5-10 gal water) D Sand Cement sack mix/7 gal water <br /> 'i Bentonite(20%solids) i Other <br /> Grout Placement Method i I Pumped D Free Fall IOthe?sgiw: -i Retardant/Accelerator(name) <br /> PEDESTAL Installed By D Driller D Pump Contractor D Other <br /> Concrete Pedestal 0Dimensions:Width ft Length ft Thick in ❑Christy Box D Stove Pipe <br /> PUMP I Submersible[,Turbine .-1 Other HP Pump Set it 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 /> UM 48 A ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED - - TITLE Managing Engineer DATE 08/08/2019 <br /> ENT <br /> IVEI� <br /> 6 2019 <br /> J )AGI.IN COUNTY <br /> E IR MENTAL <br /> H L H PARTMENT <br /> D AR ENT US ONLY <br /> c <br /> Application Accepted By Date Area ` Employee ID# <br /> Grout Inspection By Date SPECIAL Well 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 Data Permit/ Invoice# Well ID# <br /> Codes Info B mitted Servjce eqvest# <br /> 3,3q;Zi, <br /> END 43-06 revised 4/14118 WELL/PUMP PERMIT <br />