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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 /> w <br /> JOB ADDRESS 13590 W.Walnut Grove Road CITVIZIp Thonon/95666 m <br /> D <br /> Walnut Grove Road and Lamb Road 00105010 <br /> CROSS STREET APN PARCEL SIZE LAND USE APPLICATION If <br /> m <br /> OWNER NAME Reclamation District 348 PHONE 916.441.6850 <br /> OWNER ADDRESS cto Wagner 8 Bonslgnore,2151 River Plaza Drive,Suite 100 CITY/STATEIZIP Sacramento,Callfomia 95833 <br /> CONTRACTOR Huagren-Tillis Engineers PHONE 925-685-6300 <br /> CONTRACTOR ADDRESS 4085 Nelson Avenue,Suite A CITYISTATEIZIP Concord.California 94520 <br /> SUBCONTRACTOR/CONSULTANT Gregg Drilling and Testing LLC PHONE 925-313.5800 <br /> SUBCONTRACTORICONSULTANT ADDRESS 950 Howe Road CITY/STATE/ZIP Martinez.California 94553 <br /> LICENSE ❑v C-57 C C-61 C D-09 ::Other NUMBER 1044456 EXPIRATION DATE 09/30/2020 <br /> BILLING PARTY: =OWNER m CONTRACTOR - SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391)G Dibromochloropropane(4392)'-Arsenic(4393) <br /> INTENDED USE C Domestic/Private 0 Irrigation/Agricultural C Industrial C Water Quality Monitoring m Soil Sampling/Characterization <br /> C Public Water System <br /> If diff arenl from O m.: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK C New Well G Replacement Well 0 Well Alteration/Modification m Other ICvfe <br /> C Monitoring Well(s) #of wells ❑Soil Boring(s) n of boring' m Geotechnical 8 a or borings <br /> C Out-Of-Service Well C Out-Of-Service Well Renewal C Cross-Connection Repair <br /> C New Pump 0 Pump Replacement C Pump Repair C Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method O Mud Rotary C Air Rotary C Auger =Cable Tool C Push Point 0 Other Hollow-Stem and CPT <br /> Proposed Well Depth Approx 60 It Excavation in diameter C Open Bottom 0 Gravel Pack/Gravel Size in diameter <br /> C Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter 2lo a in Thickness/Gauge/ASTM Sched Steel C Plastic C Stainless Steel C Other <br /> Grout Seal Depth R 0 Neat Cement(94 lb bay5-10 gel water) C Sand Cement sack mix/7 gal water <br /> C Bentonite(20%solids) C Other <br /> Grout Placement Method C Pumped C Free Fall C Other G Retardant/Accelerator(name) <br /> PEDESTAL Installed By C Driller C Pump Contractor C Other <br /> C Concrete Pedestal--Dimensions:Width It Length It Thick in D Christy Box 0 Stove Pipe <br /> PUMP Submersible--Turbine C Other HP Pump Set ft Standing Water Level It <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINAN S, STATE WS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WIT HE CALIF _NIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION S. <br /> MINIMUM 48 H U AD E ICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED Joe Heavin TITLE Senior Engineer DATE 08/138019 <br /> DIVED <br /> 201, <br /> 1oRO�M OOUN7?' <br /> H DEAtiE-MENT <br /> DEPARTMENT USE ONLY <br /> / o l <br /> Application Accepted By Data �,` 'L J/�L 1 Area / i of Employee ID# <br /> Grout Inspection By' Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Irectiq{n By (,{1� Date377k-1ConstructQd W�11 Depth tt <br /> COMMENTST 11 "`-� <br /> i j" <br /> PE SC Recelved CheckIlll Amount Date PermlU Invoice# Well ID# <br /> Codes Info B Cash RamlttW S Ica Re uest$ <br /> a <br /> EHD43-06 6/11/2019 WELL[PUMP PERMIT <br />