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f <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 /> JOB ADDRESS 4344 S. EI Dorado St. ciry/ziP Stockton, CA 95206 m <br /> D <br /> CROSS STREET ArCh Airport Rd. APN 193-020-22 PARCEL SIZE 11.46 ac LAND USE APPLICATION# <br /> OWNER NAME Cargill, Inc. PHONE 209-982-4632 N <br /> OWNER ADDRESS 4344 EI Dorado St. CITY/STATEIZIP Stockton, CA 95206 <br /> CONTRACTOR Cascade Drilling PHONE (916)638-1169 <br /> CONTRACTOR ADDRESS 3000 Duluth St. CITYISTATE/ZIP West Sacramento, CA 95651 <br /> SUBCONTRACTOR/CONSULTANT ATC Group Services LLC PHONE 209-579-2221 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 1117 Lone Palm Ave., Ste.201 B CITYISTATEIZIP Modesto, CA 95351 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 938110 ExPIRATION DATE 9/30/19 <br /> BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391)D Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial ^_Water Quality Monitoring X 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 Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells Soil Boring(s) a of borings X Geotechnical 7 of borings <br /> Out-Of-Service Wall Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tool X Push Point Other <br /> Proposed Well Depth 8-18 ft Excavation 4 in diameter Open Bottom 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 Stainless Steel Other <br /> Grout Seal Depth 8-18 ft X Neat Cement(94 Ib bag/5-f0 gal wafer) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped X Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL installed By Driller - Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length It Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine 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 /> MINIMUM 40 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED>' TITLE VP Operations DATE 8/5/2019 <br /> A in <br /> AA <br /> ULZ <br /> ,�_R MENT LIVE O q L V pAR MENT <br /> Application Accepted By Area Employee ID# <br /> Grout Inspection By Date PECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By It n�' Lt�tUd.. _ Date�_I6 1._4_-L Constructed Well Depth ft <br /> COMMENTSI <br /> PE Sc Received Check#/ Amount Permit/odes Info B Cash emitted Date Service Ra uest# Invoice# Well ID# <br /> 5 f, <br /> It <br /> EHD43-06 W11/2019 WELL HUMP PERMIT <br />