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-1r <br /> w <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205•622(2001469-3420 <br /> NON-REFUNDABLE PERMIT _ wwwsJ�crv.ulyluhtl — EXPIRES 7 YEAR FROM DATEISSUED <br /> JOB ADDRESS 2121 N Zuckerman Rd cnyiaP Stockton/95206 <br /> Cll033STREET W Mcdonald Rd APN.129UB009 PARCELSIZE 565 LAND USE APPLICATION* b <br /> A <br /> m <br /> OWNIINNAME PG&E PHONE u <br /> OWNER ADDRESS PO Box 770000 CITYISTATEIZJP San_ Francisco/CA <br /> CONTRACTOR Gregg Drilling _ PHONE (925) 313-5800- <br /> CONTRACTORAODRES8 950 Howe Road crrr/sTATEILPMartinez/CA/-94553 .. <br /> SUBCONTRACTORICONSULTANT Kleinfelder, PHONE (209)948-1345 <br /> StInCOP11 RAC TOWCONSUL TAN T ADDRESS 2001 Arch Airport Rd CITYISTATEI21PSt ockton/CA/95206 <br /> LICENSE XC-57 .1 C-61 _.D-09 •.Other NUMBER_1044456 EXPIRATION DATE 09/30/2020 <br /> DILLINOPARTY: r.;OWNER L'CONTRACTOR >(SUBCONTRACTORICONSULTANT <br /> DOMCSTIc WELL SAMPLING;D General Mlneral/Coliform Bacteria(4391)0 Dibromochloropropane(4392)D Arsenic(4393) <br /> INTERosD USE O DomesticJPrivete n Irrigeflon/Agricultural D Industrial D Water Ouallty Monitoring r Soil Sompting/Cheracterizallon <br /> a Public Water System__ <br /> Ifdinerenl from Owner: Water Syolem Nome Contact Name or Phone Number <br /> TYPE OF WORK J New Well I-'Replacement Well D Wall Alteratlon/Modificallon 0 Other <br /> C Monitoring Wells) #ofwells 0 Soil Boring(s) sof besnaa XGeotechnicai 2 Sof boring, <br /> n Out-Of-Service Well O Out-Of-Service Well Renewal I]Cross-Connectlon Repair <br /> O New Pump_ i I Pump Replacement I Punyl lop If _ i 1 Ralso Wall Casing <br /> WELL CONSTIt11C1mN <br /> Drllling Method D Mud Rotary 2 Air Rotary :n Auger L)Cable Tool XPush Point ❑ Other-_,___ <br /> Proposed Well Depth 80-100 ft Excavation 2 In diameter 0 Open Bottom I;Gravel Pack/Gravel Size. In diameter <br /> D Conductor Casing In diameter I Conductor Casing Depth ft <br /> Wait Casing Dlamelpr,�rin frhickness/Gouge/ASTM Schad D Steel D Plastic ::Stainless Steel C Other <br /> Groul9eal Depth IJi�L'f 0O—•ft C Neat Cement(94 lb bag/5.10 gel wafer) Cl Sand Cement __Sack mixl7 gal water <br /> O Bentonite(20%solids) D Other <br /> Grout Placement Method x P111e pod :.I Free Fall Other TYem—ie D Retardant/Accelerator(lome) <br /> PEDESTAL Installed By 3 Driller 0 Pump Contractor 0 Other <br /> D Concrete Pedestal aDlmensiona:Widlh—4 Length ft Thick in :1 Christy Box r?Stove Pipe <br /> IpUMP ❑ <br /> Submersiblec.Turbine *]Other— HP Pump Sel ft Standing Water Laver <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 AID ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS 1: MMNSTION LAWS. <br /> MINOUR VA .E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)95'-769Q7 '^ <br /> SIGNED TITLE �`"'�•- �" DATE / 7 l�Zd <br /> - - <br /> ---- --- - -- -- - - -= RF yMF�►T <br /> - - - - ---- - -- - E� <br /> X04 9 ?020 <br /> — — — — --- — — — - --- ----- — — — THR�NMF0 <br /> -- __-- ---- --- --- — ---- Dip M H� <br /> DE RTMEN7 USB NLY <br /> Application Accepted By _ Dale -oArea Employee IDk <br /> Grout Inspection By Date E." PECI L Well Permlt <br /> Pump Inspection By Dale WAIVER Received <br /> Soil Boring Inspection By1:1-466Z Dale 20-W Constructed Well Depth —ft <br /> COMMENTS <br /> PE SC Received Checkpf Amount PermlU <br /> Dale Invoice N Well IDN <br /> Codes Info _ Cs Remitted__ Servlc�quastM <br /> ER04340 0111/2019 d WELL IPUMP PERMrr <br />