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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)4683420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Y en Y wa <br /> JOB ADDRESS P. <br /> NE of River Island Parkway&GoldValle ParkLathrop,95330 <br /> Y CfTYIZIP <br /> D <br /> CROSS STREET Golden Valley Parkway ApN 192040-340,-360,-400, PARCEL SIZE8 82 ACSNO USE APPLICATION# O <br /> Lathrop Land Acquisition.LLC,dba Saybrook Fund Advisors;attn.Scott Bayliss 310-601-3705 m <br /> OWNER NAME PHONE w <br /> OWNER ADDRESS 221 N.Kansas St.,Suite 700 CITY/STATEmp EI Paso/TX/79901 <br /> CONTRACTOR Salem Engineering Group,Inc. PHONE 559-271-9700 <br /> CONTRACTOR ADDREss 4729 W.Jacquelyn Avenue crry/STATEmp Fresno/CA/93722 <br /> SUBCONTRACTOR Salem Engineering Group, Inc. PHONE 559-271-9700 <br /> SUBCONTRACTOR ADDREss 4729W.Jacquelyn Avenue CIT`r/STATEmP Fresno/CA/93722 <br /> LICENSE VC-57 LI C-61 I I D-09 II Other NUMBER 970772 ExpIRATIONDATE 3/31/2020 <br /> DoMsTIc WELL SAMPLING'.J General Mineral/Coliform Bacteria(4391) :Dibromochloropropane(4392)L Arsenic(4393) <br /> INTENDED USE D DomesticlPrivate ❑Irrigation/Agricultural 7 Industrial Water Quality Monitoring Soil Sampling/Charactenzation <br /> D Public Water System <br /> If afferent from 0­: Water System Name Contact Nerve or Phone Number <br /> TYPE OF WORK D New Well r_Replacement Well L:Well Alteration/Modification C Other <br /> D Monitoring Well(s) #of wells a Soil Boring(s) "borings borings VGeotechnical 9 If of bonnps <br /> D Out-Of-Service Well L!Out-Of-Service Well Renewal D Cross-Connection Repair <br /> D New Pum J Pump Replacement n Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary ':Air Rotary /Auger Cable Tool Push Point D Other ��� �/� <br /> PrdXbsed Well Depth i l7 ft 6ecavation n diameter Open Bottom Gravel Pack/Gravel Size n diameter jl�•Y <br /> .Conductor Casing in diameter / Conductor Casing Depth It �►/1 <br /> VX1 Casing Diameter in Thidmess/Gauge/ASTM Schad i.Steel ;7 Plastic Stainless Steel 7 Other <br /> Grout Seal Depth 4' -fes It VNeat Cement(94 Ib bag/5-10 gal water) '7 Sand Cement sack mix/]gal water <br /> :I Bentonite(20%solids) D Other j'/d i� <br /> Grout Placement Method D Pumped Li Free Fall ,Other Tremie Pipe I Retardant/Accelerator(name) �OAQU/N C N <br /> PE STAL Installed By D Driller D Pump Contractor Ct Other T IV <br /> LI Concrete Pedestal[]Dimensions:Width <br /> It Length ft Thick in I I Christy Box ❑Stove Pipe A <br /> —PYP D SubmersibleC Turbine LI Other HP Pump Set ft Standing Water Level ft ENT <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WALL 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 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL(209)953-7697 <br /> SIGNED Slakoi Feich TITLE Geotechnical Project Engineer DATE 1/22/2020 <br /> ;:!LRTMENT U E NLYApplication Accepted By � Date, �� Area �mployee <br /> Grout Inspection By Date F1 SPECIAL Well Permit <br /> Pump Inspection By Date r7 WAIVER Received <br /> Soil Boring Ins ecb By qK Date Constructed Well De It <br /> COMMEN S — / O �/ 1 <br /> O 2 - IA.;T Q^ u� 1 <br /> PE SC Received Amount • Permit/ <br /> Codes Inco Cash Remitted Date Serviee Re uest# Invoice# Well ID# �fvf <br /> A- <br /> EHD 43-06­­d4114/18 WELL)PUMP PERMIT <br />