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14 <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 /> Joe ADDRESS 508 W.Grant Line Road CITY/ZIP Tracy,California <br /> D <br /> CROSS STREET APN 233-030-10 PARCEL SIZE - LAND USE APPLICATION# O <br /> A <br /> OWNER NAME Ramn ek Singh PHONE 415-203-2416 N <br /> OWNERADDRESS 673 W.Rico Way CITYISTATE/ZIP Tracy,CA 95376 <br /> CONTRACTOR Krazan&Associates,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 CITY/STATE/ZIP Clovis.California 93612 <br /> LICENSE VC-57 C-61 D-09 I Other NUMBER 499908 EXPIRATION DATE 10.31.2020 <br /> DOMESTIC WELL SAMPLING:7 General Mineral/Coliform Bacteria(4391)❑Dibromochloropropane(4392)" Arsenic(4393) <br /> INTENDED USE D Domestic/Private D Irrigation/Agricultural O Industrial 0 Water Quality Monitoring D Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK D New Well r:Replacement Well D Well Alteration/Modification 17 Other <br /> Monitoring Well(s) #of wells D Soil Boring(s) #of borings Geotechnical_2 or borings <br /> Out-Of-Service Well D Out-Of-Service Well Renewal D Cross-Connection Repair <br /> New Pump Pump Replacement D Pump Repair D Raise Well Casio <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary /r Auger Cable Tool D Push Point Other <br /> r <br /> Proposed Well Depth (1)r-490 ft Excavation in diameter 1 Open Bottom Gravel Pack/Gravel Size in diameter <br /> i i Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in 0 Thickness/Gauge/ASTM Sched Steel i Plastic Stainless Steel Other <br /> Grout Seal Depth10! —!FjL It /Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) ' Other <br /> Grout Placement Method Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal 'Dimensions:Width ft Length fl Thick in Christy Box Stove Pipe <br /> PUMP Submersible'- Turbine ' Other HP Pump Set It Standing Water Level fl <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 AD NC OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Managing Engineer DATE 10/30/2019 <br /> 4 <br /> CyM�NP <br /> ��VED <br /> o y ?419 <br /> A TMENT U)S E N L Y <br /> Application Accepted By ate l Area--- Employee ID#1 <br /> Grout Inspection By Date 1*SPECIAL We11 Permit <br /> Pump Inspection By Date 11 WAIVER Received <br /> Soil Boring pection By Date Constructed Well Depth ft <br /> COMMENTS -Sft <br /> PE SC Received Chec Amount Permit/ <br /> Codes Info By_ Remitteck 0 to Service Request# Invoice# WeI11D# <br /> EH043-0e revised,111411e <br /> WELL/PUMP PERMIT <br />