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f <br /> ' WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232 (209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3230 WEST IN.&1360 E ALPINE AVENUE CInZP STOCKTON,92504 y <br /> SEC WEST AND ALPINE r <br /> CROSS STREET APN 117-oeana000& PARCEL SIZE 45,136 LAND USE APPLICATION# A <br /> OWNER NAME 5 POINTS PLAZA,LLC 117-08x05 PHONE 310-923-2594 y <br /> OWNER ADDRESS 1180 SOUTH BEVERLY DRIVE,SUITE 300 CITY/STATE/LP LA,CA 90035 <br /> CONTRACTOR Moore Twining Associates,Inc. PHONE 1-800-268-7021 <br /> CONTRACTOR ADDRESS 2527 Fresno Street CITY/STATE/ZIP Fresno,CA.93721 <br /> SUBCONTRACTOR/CONSuLTANT HARRINGTON GEOTECHNICAL ENGINEERING,INC. PHONE 714-637-3093 <br /> SuBcoNTRAcToR/CoNsuLTANTADDRESS 1590 NORTH BRIAN STREET CITY/STATE/LP ORANGE.CA 92867 <br /> LICENSE d(C-57 ❑C-01 ❑D-09 0 Other NUMBER 506159 EXPIRATION DATE 2-28-2021 <br /> BILLING PARTY: ❑OWNER ❑CONTRACTOR R SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:0 General Mineral/Coliform Bacteria(4391)0 Dibromochloropropane(4392)0 Arsenic(4393) <br /> INTENDED USE ❑Domestic/Private ❑Irrigation/Agricultural ❑Industrial ❑Water Quality Monitoring X Soil Sampling/Characterization <br /> ❑Public Water System <br /> If dlRerent 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 1 #of borings K Geotechnical #of bodngs <br /> ❑Out-Of-Service Well []Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> ❑New Pump D Pump Replacement ❑Pump Repair ❑Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑Mud Rotary D Air Rotary p Auger 0 Cable Tool []Push Point ❑ Other <br /> Proposed Well DepthZb-7-5 ft Excavation in diameter ❑Open Bottom []Gravel Pack/Gravel Size in diameter <br /> ❑Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad ❑Steel ❑Plastic ❑Stainless Steel ❑Other <br /> Grout Seal Depth Z6 X Neat Cement(94 lb bag/610 gal water) ❑Sand Cement sack mix/7 gal water <br /> ❑Bentonite(20%solids) ❑Other <br /> Grout Placement Method ❑Pumped_X Free Fall 0 Othe ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other <br /> ❑Concrete Pedestal[]Dimensions:Width ft Length It Thick in ❑Christy Box ❑Stove Pipe <br /> PUMP D Submersible[]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. 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 /> TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> INIMU 8 HOUR ADV NO <br /> SIGNED TITLE Drilling Division Manager DATE 1-2-2020 <br /> 00 4 <br /> 01' "020 <br /> L'/ Q0/ <br /> DFpgRT 4 <br /> ME,yT <br /> oolol <br /> EP RTMENT U E NLY nn / <br /> Application Accepted By Date Area _ Employee ID#_�j <br /> Grout Inspection By Date L 1 SPECIAL Well Permit <br /> Pump Inspection By Date LI WAIVER Received <br /> Soil Boring Inspection By Date /Zo,onstructed Well Depth ft <br /> COMMENTS - <br /> PE SC Received eck Amount D to Permitl Invoice# Well ID# <br /> Codes Info Remitt d Service Request# <br /> 0 <br /> EHD 43-00 6/112019 WELLIPUMPPERMIT <br />