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s � <br /> It <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 500 East Louise Avenue cITY/zfP Lathrop/ 95330 m <br /> Cambridge Drive n <br /> CROSS STREET g APN 198-120-080-D0� PARCEL SIZE 117 aC LAND USE APPLICATION# N/A o <br /> A <br /> OWNER NAME ASP/RWM Properties,R&B Louise,LLC and R&B Delta,LLC,C/O ECS Corp PHONE Roger Ashton 925-969-9245 y <br /> OWNER ADDRESS - 2228 Livingston Street CITY/STATEMP Oakland,CA 94606 <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS Cn"Y/STATE/ZIP <br /> SUBCONTRACTOR Cascade Drilling,LP PHONE 530-662-2829 <br /> SUBCONTRACTOR ADDRESS 3000 Duluth Street CITY/$TATE/ZIP West Sacramento,CA 95691 <br /> LICENSE Xl C-57 D C-61❑D-09 0 Other NUMBER 938110 EXPIRATION DATE 09/30/2019 <br /> DOMESTIC WELL SAMPLING:D General Mineral/Coliform Bacteria(4391)b Dibromochloropropane(4392)0 Arsenic(4393) <br /> INTENDED USE D DomesticJPrivate 0 Irrigation/Agricultural ❑Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br /> D Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE Or WORK D New Well❑Replacement Well D Well Alteration/Modification D Other <br /> ❑Monitoring Well(s) #of wells D Soil Borings) #of borings X0 Geotechnical-6-#of borings <br /> 0 Out-Of-Service Well 0 Out-Of-Service Well Renewal D Cross-Connection Repair <br /> 0 New Pump ❑Pump Replacement D Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑Mud Rotary D Air Rotary 0 Auger D Cable Tool ❑Push Point X Other Sonic Drilling <br /> Proposed Well Depth 15-30' ft Excavation 6e in diameter ❑Open Bottom D Gravel Pack/Gravel Size in diameter <br /> D Conductor Casing N/A in diameter / Conductor Casing Depth N/A It <br /> Well Casing DiameterIAin Thickness/Gauge/ASTM Sched ❑Steel ❑Plastic ❑Stainless Steel ❑Other_ <br /> Grout Seal Depth 15-30' ft IX Neat Cement(94 Ib bag15-10 gal water) ❑Sand Cement sack mixl7 gal wate <br /> D Bentonite(20%solids) ❑Other <br /> Grout Placement Method ❑Pumped 0 Free Fall IX Other Tremie D Retardant/Accelerator(name) <br /> PEDESTAL Installed By D Driller D Pump Contractor ❑ Other <br /> 0 Concrete Pedestal DDimensions:Width ft Length ft Thick in D Christy Box ❑Stove Pipe <br /> PUMP ❑SubmersibleD 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. 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 ►1' <br /> WORKERS COMPENSATION LAWS. r1 <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �� TITLE Project Manager DATE 9/03/2019 r <br /> PA <br /> 1Vr <br /> c'FF jV <br /> N /RpUMECpUNN <br /> N <br /> �FPAR MFNT <br /> jjA'ENT USA O/LY <br /> Application Accepted By e d C Are Employee ID#�(� , <br /> Grout Inspection By Date Srf f 0PECIAL ell Permit <br /> Pump Inspection By Date / WAIVER eceived <br /> Soil Boring Inspection By Date f�/1 Constructed Well Depth ft <br /> COMMENTS Out- ` <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Servic Re uest# <br /> 1SA <br /> 3 <br /> EHD43-06 reNsed4/14/18 WELL/PUMP PERMIT <br />