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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232 (209)4683420 <br /> NON-REFUNDABLE PERMIT www.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> LA <br /> Joe ADDRESS 7400 S.Delivery Drive CITY/7jp French Camp 95231 <br /> D <br /> CROSS STREET Recovery Road ApN 19305018 PARCEL SIZE 138.61 LAND USE APPLICATION# o <br /> OWNER NAMEL JT\'1/K V PHONE w <br /> OWNER ADDRESS ` CITY/STATE/7jP <br /> CONTRACTOR Kleinfelder PHONE 209-948-1345 <br /> CONTRACTOR ADDRESS 2001 Arch Airport Road CITY/STATEZP Stockton,CA 95206 <br /> SUBCONTRACTORICONSULTANT V&W Drilling PHONE 209.469-7700 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 1133 Blackhurst Dr. CITY/STATEIZIP Galt,CA 95632 <br /> LICENSE A C-57 U C-61 0 D-09 0 Other NUMBER 720904 EXPIRATION DATE 4/30/2020 <br /> BILLING PARTY: ❑OWNER X CONTRACTOR ❑ SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:0 General Mineral/Coliform Bacteria(4391)❑Dibromochloropropane(4392)0 Arsenic(4393) <br /> INTENDED USE ❑Domestic/Private c Irrigation/Agricultural ❑Industrial D Water Quality Monitoring X Soil Sampling/Characterization <br /> 0 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 0 Soil Boring(s) #of borings X Geotechnical 4 #of borings <br /> ❑Out-Of-Service Well 0 Out-Of--Service Well Renewal 0 Cross-Connection Repair <br /> D New Pump ❑Pump Replacement 0 Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 8 Mud Rotary 0 Air Rotary X Auger ❑Cable Tool ❑Push Point ❑ Other <br /> Proposed Well Depth 50 ft Excavation in diameter D Open Bottom 0 Gravel Pack/Gravel Size in diameter <br /> ❑Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad 0 Steel 0 Plastic ❑Stainless Steel ❑Other <br /> Grout Seal Depth ft R Neat Cement(94 Ib bag/5-10 gal water) ❑Sand Cement sack mixf7 gal water <br /> ❑Bentonite(20%solids) 0 Other <br /> Grout Placement Method i8 Pumped ❑Free Fall Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller 0 Pump Contractor 0 Other <br /> 0 Concrete Pedestal❑Dimensions:Width ft Length ft Thick in ❑Christy Box ❑Stove Pipe <br /> PUMP ❑Submersible❑Turbine ❑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 ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 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 /> MINI UM 48 HO�U�R/ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED W TITLE Project Engineering Geologist DATE 10-8-2019 <br /> ®��® <br /> v®� 201.9 <br /> NC <br /> ART o��ry <br /> MFNr <br /> th <br /> MENT U E N Y <br /> Application Accepted By Date Area Employee ID# <br /> Grout Inspection By Date PECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> p11 <br /> Soil Boring Inspection By Pmt r �(� Date � Constructed Well Depth ft <br /> COMMENTS / <br /> PE Sc Received Check#/ Amount Permit V <br /> od Info Ca emitted D e Service Re uest# Invoice# Well 1D# <br /> EHD 47-06 6/112019 ����� �'7/�" —7/� WELL/PUMP PERMIT <br />