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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> 4 NON-REFUNDABLE PERMIT CAL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Turnpike Road and Lincoln Street CtTvILP Stockton,CA to� <br /> CROSS STREET Umwaj APN PARCEL SIZE LAND USE APPLICATION# F <br /> OWNER NAME Housing Authority County of San Jaoquin PHONE 209.460-5042 m <br /> OWNER ADDRESS 2575 Grand Canal Blvd CITY/STATE/ZIP Stockton,CA 95207 <br /> CONTRACTOR Krazan&ASSOCiales,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITYISTATEIZIP Clovis,California 93612 <br /> LICENSE /C-57 I C-61 ;I D-09 r Other NUMBER 499908 EXPIRATION DATE 10.31.2020 <br /> DOMESTIC WELL SAMPLING: General MineraVColiform Bacteria(4391) Dibromochloropropane(4392)I'Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring 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 Wells) #of wells Soil Borings) a o1 borings V Geotechnical 4 a of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair 110 20 Feet) <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud--R_-`otary f Air Rotary ./Auger Cable Tool Push Point Other <br /> Proposed Well Depth It Excavation in diameter Open Bottom .Gravel Pack/Gravel Size in diameter <br /> 7 Conductor Casing in diameter / Conductor Casing Depth It <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched a Steel I Plastic . Stainless Steel Other <br /> Grout Seal Dept fl y Neat Cement(94 Ib bag15-10 gal water) a Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) ❑Other <br /> Grout Placement Method ❑Pumped D Free Fall F1 Other n Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller ❑Pump Contractor ❑ Other <br /> :,Concrete Pedestal ODImensions:Width ft Length It Thick in ❑Christy Box ❑Stove Pipe <br /> PUMP n Submersibles,Turbine ❑Other HP Pump Sel h 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 HO ADV NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED` Managing Engineer DATE 10/23/2019 <br /> ?�° 019 <br /> U)N CO <br /> c pqR ��ry <br /> �P RTMENT U <br /> Application Accepted By Date Area ...j 11 Employee ID#� <br /> Grout Inspection By Date PECIAL Well Permit <br /> Pump Inspection By Dale—J /�//�/tL�g WAIVER Received <br /> Soil Boring Inspection By Date ! Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Amount D to Permit/ Invoice# Well ID# <br /> Codes Info Cash mitted Service Re uesI# <br /> v 4oa1a <br /> EHD 43-06 revised 4/14118 <br /> WELL(PUMP PERMIT <br />