Laserfiche WebLink
�t <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205$232(209)468.3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 4501 N. Pershing Ave CITY/LP Stockton,CA 92507 spy <br /> CROSS STREET Rosemarie Ln APNO PARCEL SIZE LAND USE APPLICATION# v <br /> m <br /> OWNER NAME 7-Eleven Inc. PHONE 972-828-6592 y <br /> OWNER ADDRESS <br /> PO Box 711 CITY/STATE/ZIP Dallas TX 75221 <br /> CONTRACTOR Moore Twining Associates PHONE 1800-268-7021 <br /> CONTRACTOR ADDRESS 2527 Fresno St CITY/STATEIZIP Fresno,CA 93721 <br /> SUBCONTRACTORICONSULTANT Stanlec Consulting Services,Inc. PHONE 909-335-6116 <br /> SUBCONTRACTOWCONSULTANT ADDRESS 735 E.Camegle Dr.Ste 280 CITYISTATE/ZIP San Bernardino,CA 92408 <br /> LICENSE X C-57 ❑C-61 U D-09 ❑Other NUMBER <br /> 506159 EXPIRATION DATE 2-28-21 <br /> BILLING PARTY: D OWNER D CONTRACTOR X7 SUBCONTRACTORICONSULTANT <br /> DOMESTICWELLSAMPLING:❑General Mineral/Coliform Bacteria(4391)❑Dibromochloropropane(4392)D Arsenic(4393) <br /> INTENDED USE 0 Domestic/Private 0 Irrigation/Agricultural D Industrial O Water Quality Monitoring N Soil Sampling/Characterization <br /> D Public Water System <br /> If diffcront from Owner: Water System Name Contact Nemo or Phone Number <br /> TYPE OF WORK D New Well ❑Replacement Well 0 Well Alteration/Modification D Other <br /> 0 Monitoring Well(s) #of wells ❑Soil Boring(s) #of bodngs7 Geotechnical 2 #of borings <br /> ❑Out-Of-Service Well D Out-Of-Service Well Renewal ❑Cross-Connection Repair <br /> D New Pump D Pump Replacement ❑Pump Repair ❑Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method D Mud Rotary ❑Air Rotary X Auger ❑Cable Tool 0 Push Point ❑ Other <br /> Proposed Well Depth It Excavation In diameter ❑Open Bottom ❑Gravel Pack/Gravel Size in diameter <br /> 0 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad ❑Steel D Plastic D Stainless Steel D Other <br /> Grout Seal Depth 50 ft XI Neal Cement(94/b bag/5-10 gal water) D Sand Cement sack mix[7 gal water <br /> ❑Bentonite(20%solids) D Other <br /> Grout Placement Method X]Pumped 13 Free Fall ❑Other D Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller O Pump Contractor n Other <br /> D Concrete Pedestal ODlmenslons:Width It Length It Thick in D Christy Box ❑Stove Pipe <br /> PUMP D SubmersibleD Turbine D 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 /> hIlINIIPM D E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> i 0- 11/26/19 <br /> $ZONED TITLE (fy DATE <br /> R A yny�1T <br /> OV <br /> ��p '-:' At rY <br /> - �RTMENT <br /> ASR' MENT U E O LY <br /> Application Accepted By a Area EmployeelD#� <br /> Grout Inspection By Data. ❑ SPECIAL Well Permit <br /> Pump Inspection By ,Date ❑ WAIVER Received <br /> Soil Boring Inspection By �-�� Bate Z Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/ <br /> Codes info 8 Ca h e itted Date S rvice Request# Invoice# Well ID# <br /> EHD 43-08 6/71/2819 WELL(PUMP PERMIT/0117Y567 <br />