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WELL/PUMP PERMIT <br /> t SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT 4 CAL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> rn <br /> JOB ADDRESS 25499 East Flood RoadCITY/ZIP Linden.CA <br /> s _�y.s D <br /> CROSS STREET ESCSIOn Bel101a Road <br /> AP �'O PARCEL SIZEi/�% � LANO USE APPLICATION# a <br /> OWNER NAME Foster Farms �7 /t1 PHONE 209-398-6716 m <br /> OWNER ADDRESS 14519 W.Collier Road ' fr(7 �i(]� (.}'�j CITY/STATE/LP Delhi,CA 9531.5 `/j <br /> CONTRACTOR Krazan&Associates,Inc. i PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATEIZIP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITYISTATE/ZIP Clovis,California 93612 <br /> LICENSE /C-57 1_7 C-61 I D-09 Other NUMBER 499906 EXPIRATION DATE 10.31.2020 <br /> DoMEsnc WELL SAMPLING:n General Mineral/Coliform Bacteria(4391)F Dibromochloropropane(4392)" Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural ,Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> Vdifferent from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well I Replacement Well I i Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells D Soil Borings) n of borings yF Geotechnical 1 #of borings <br /> Out-Of-Service Well l:Out-Of-Service Well Renewal Cross-Connection Repair--757e—et) <br /> New Pump I I Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑Mud Rotary rl Air Rotary Auger ❑Cable Tool Il Push Point ' Other <br /> Proposed Well Depth it Excavation in diameter ❑Open Bottom ❑Gravel Pack/Gravel Size in diameter <br /> n Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched ❑Steel D Plastic a Stainless Steel ❑Other <br /> Grout Seal Depth ft V Neat Cement(94 lb bag/5-10 gal water) D Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) G Other <br /> Grout Placement Method I Pumped [l Free Fall ❑Other ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By 17 Driller ❑ Pump Contractor [-. Other <br /> Concrete Pedestal DDimensions:Width it Length ft Thick in ❑Christy Box ❑Stove Pipe <br /> PUMP ❑SubmersibleC 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 48 A NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 � <br /> SIGNED TITLE Managing Engineer DATE P <br /> J <br /> 2019 <br /> NV RAN/N COV <br /> 7-171 <br /> ,PA T M E N T U E O LY <br /> Application Accepted By Date Area Employee ID#� <br /> Grout Inspection By Date ECIAL 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 (ChegW Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Remitted Service Ro uest# <br /> X-3 WP 0400 A <br /> EHO 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />