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WP0039639
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039639
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Entry Properties
Last modified
11/20/2024 8:50:34 AM
Creation date
10/17/2019 10:08:47 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039639
PE
4381
STREET_NUMBER
27511
Direction
E
STREET_NAME
STATE ROUTE 26
City
LINDEN
Zip
95236-
APN
06724003
ENTERED_DATE
5/22/2019 12:00:00 AM
SITE_LOCATION
27511 E HWY 26
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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Tags
EHD - Public
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' 1 WELL/PUMP PERMIT <br /> I SAN JOAQUIN COUNTY ENVIRONTB DEPA MENT 600 EAST MACH STREET-SlocKTON CA95M-(109)168-3420 <br /> NO-N-REKUN►AABI.E PRR,.MENT EXPIRES I YEARFR(IM DATE ISSUED <br /> AP i v� ..- _ PARCELSIZE _ <br /> 0%%ER ADDRESS V v/''���'^_ _�_/,f CITYMAATTIUr4r.-�-�_____�___.,_„�_� <br /> Wsk <br /> CO%TRACTOR gig G(/ //,,, -L+L V /,_Y 6_ <br /> CONTRACTOR ADDRESS /D Z�+ Clll/STATElLI! <br /> SUBCONTRACTOR PM)NE <br /> r StSCONTRACTORADDRSS CrrY/STATTizir <br /> Lic6NSE ❑C-57 C-61 ❑D4)9 D Other NVMDER T EKHR1rtoN Wku J <br /> I GEOGRAmwALINFMLA'rwh: Coordfamtes X Y 10%Rskip_ Range Seethe <br /> d <br /> INTE%DEo Use ❑DomcsticlPriratc Ir:igatiotL'Agricuhunal ❑Induariai ❑Water Quality SfonitcRing ❑Soil Samplinvehamcicrization y® <br /> D Polk Water system <br /> Ifdin'rnoi aan:IMrKt�-- waKr$Siem Mame l•u®xVamc or time YuaS:r '�e�� <br /> Tt eE Or WORK 13 New%cU E3 Replacement Well ❑Well AlterAion/Modificalion 13 Test Hole ❑Other _- ���1��� <br /> ❑Monitoring Wtll(S) nvmt—fw 11' ❑Soil BoriU2(5) nm a`ref vrim 13Gcoteebaical _ na.rabofhatM <br /> ❑Well Destruction D Out-Of-Smice Well ❑Out-0F-Sm ice Well Renewal ATA{ 2 2 <br /> New P. O Pump R m ❑Pump Repair ❑Cross-Connection Repair <br /> WELL CONSTRU l JQ <br /> Drilling Method ❑Mud Rotary ❑Air Rotary D Auger D Cable Tool D Push Point ❑Other _ �l,I�/ . Qu//V co <br /> SUN <br /> Proposed Well Depth fl Excavation in diameter ❑Open Bottom ❑Gravel Pack i Gravel Size u��+�,d. 'H 0�p ENTAL N <br /> D Conductor Casing in diameter / Conductor Casing Depth 111 <br /> ART <br /> Well Casing Diarneter lin Thickness Gaugc'ASTM Schcd ❑Steel ❑Plastic ❑Stainless Steel ❑Other MENr <br /> Grout Seal Depth—ft D Neat Cement(941b hag 15-10 gal wurer) 0 Sand Cement suck mtr;7 gal water <br /> ❑Bentonite(2014 solids) ❑Manufacturer Spec%solids °: Name ❑Specs on File ❑Specs Submitted <br /> Grant Placement Method ❑Piumped D Free Fall ❑Other— ❑Retardant.,Accelerator(come) <br /> PEDESTAL Instsued By ❑Driller ❑Pump Contractor ❑Otber_--- <br /> D Concrete Pedestal Wmessinus: Width_ft Length_a Thick in ❑CkrNty BRa ❑Stave <br /> PUMP ubmersiblc Turbine ❑Other HP Pump Set, Standing water L.,el ft <br /> WELL DESTRUCTION, ❑Open floncmn ❑Gravel Pack ❑Un, c ❑Other <br /> WCII Diameter__in Tats]Degh ft Dcptbto Water—_—ft ❑Casing to be Pcrturatcd from,—»it to ft <br /> Scaling Material ❑Neat Cement(941b bag 15-10 gal%wer) ❑Sand C=wnk_..__sack mix/7 gal water ❑Bentonite Pellets <br /> D Bentonite 00%solids)- ❑Manufacturer Spec%Solids—Si Nam^� ❑Specs on Fie ❑Specs Sublru lied <br /> Placement Metked ❑(Hooped 0 Free Fall ❑other. <br /> ❑Complete with Mushroom Cap ft below grade ❑Complete to Existing Surface Pad <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 REQ16WD LICENSE IS <br /> CLkRE`T AND ACTIVE WI CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I A-M LV COMPLIANCE WITH ALL <br /> WORKERS CO.A <br /> SIG.I' TITLE i/^�/✓ DATE <br /> I ' <br /> 9 .ARTMENT L <br /> Appl cation Accepted By e /�/]/y .Una Employee IDx <br /> Grout Inspection By Date 'r�/ PECIAL Well Pemdt <br /> Pump Inspection By Datcb�� O WAIVERReeelved <br /> Destruction Inspection By Dat.; Constructed Wall Depth <br /> COMMENTS <br /> PE SC Recehed I Amount PeraaiN <br /> C Info •led Dam ice N invoice# we"JIM <br /> d <br /> EHD 43-02-006 WEB Well Permit and Dechranomdoe <br /> 9/11/2007 <br />
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