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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 /> m <br /> JOB ADDRESS 23505 N.Lamb Road CITY/Zip Thorton/95686 m <br /> A <br /> CROSS STREET Walnut Grove Road and Lamb Road APN 00105025 PARCEL SIZE LAND USE APPLICATION# p <br /> OWNER NAME Reclamallon District 348 PHONE 916441-6850 <br /> OWNER ADDRESS rJo Wagner 6 Bonsignore,2151 River Plaza Drive,Suite 100 CITYISTATE/ZIP Sacramento,California 95833 <br /> CONTRACTOR Hullgren-Tlllis Engineers PHONE 925-685-6300 <br /> CONTRACTOR ADDRESS 4065 Nelson Avenue,Suite A CrrYISTATEIZIP Concord.California 94520 <br /> SUBCONTRACTORICONSULTANT Gregg Drilling and Testing LLC PHONE 925-313-5800 <br /> SUBCONTRACTORICONSULTANT ADDRESS 950 Howe Road CITYISTATEIZIP Martinez,California 94553 <br /> LICENSE Q C-57 C C-61 Z D-09 C Othef NUMBER 1044456 EXPIRATION DATE 09/30/2020 <br /> BILLING PARTY: -OWNER m CONTRACTOR - SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING:C General Mineral/Coliform Bacteria(4391) Dibromochloropropene(4392)C Arsenic(4393) <br /> INTENDED USE C Domestic/Private C Irrigation/Agricultural G Industrial -Water Quality Monitoring m Soil Sampling/Characterization <br /> C Public Water System <br /> If different from Own., Water System Name Contact Name or Phons Number <br /> TYPE OF WORK C New Well C Replacement Well C Well Alteration/Modification m Other I cvr <br /> C Monitoring Well(s) #of wells ❑Soil Bonng(s) n of boring' m Geotechnical 4 #of borings <br /> C Out-Of-Service Well C Out-Of-Service Well Renewal C Cross-Connection Repair <br /> C New Pump C Pump Replacement C Pump Repair C Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method❑Mud Rotary C Air Rotary C Auger G Cable Tool C Push Point El Other Hollow-Stem and CPT <br /> Proposed Well Depth Approx 60 it Excavation in diameter C Open Bottom C Gravel Pack/Gravel Size in diameter <br /> C Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter 2toe in Thickness/Gauge/ASTM Schad -Steel C Plastic C Stainless Steel C Other <br /> Grout Seal Depth ft 0 Neat Cement(94 Ib beg/5-10 gel water) Sand Cement sack mix/7 gal water <br /> C Bentonite(20%solids) E Other <br /> Grout Placement Method C Pumped C Free Fall -Other -Retardant/Accelerator(name) <br /> PEDTInstalled By --Driller C Pump Contractor i Other <br /> ESAL <br /> C Concrete Pedestal DDlmenslons:Width ft Length It Thick in C Christy Box C Stove Pipe <br /> PUMP C SubmersibleE Turbine C 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 ORDINANC , STATE AWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH HE CALIF RNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION 5. Pay <br /> MINIMUM 48 HO ADY!!7 <br /> CE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 ,A//�b)••//�A�yII////��� <br /> SIGNED Joe Heavin TITLE Senior Engineer DATE 08/13/2019 �A�_ , � <br /> ry <br /> 01 <br /> E/ ,/"?O VAN CO <br /> ^ DEPA TMENT USE ONLY <br /> � 1 ZDate � Area Accepted By iY f�f ,h�K12 r` <br /> Employee ID# �l <br /> Grout Inspection By Date _ PECIAL Well Permit <br /> Pump Inspection By DateWAIVERWAIVER Received <br /> Soil Boring Inspection BlwaDete 1/I / 1_I Constructs ell apth ft <br /> COMMENTS r �-" {�' r <br /> PE Sc Received Check*/ Amount Permit/ <br /> Codes Info By— Cash Remitted Date Ice Re u s >7 Invoice# Wall IDS <br /> EHD 43-0a 6/11/2018 WELL!PUMP PERMIT�� /� �L���, <br />