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h <br /> f <br /> WELL/PUMP PERMIT -WELL#1 <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/ohd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Adjacent to 12988 Neugebauer Road. WELL#/ 7 LA <br /> JOB ADDRESS 1 9 (GPS:37.97869G,-121.47_721 ;ITvmP Stockton CA 95206 � <br /> D <br /> CROSS STREET McDonald River BridgeAPN 1310202 PARCEL SIZELAND USE APPLICATION# <br /> OWNER NAME City of Stockton /7W LA&VAI d�llibs uL� PHONE <br /> OWNER ADDRESS City Hall,425 N,EI Dorado StStC1/b 3 6(q /.LD//tr�'�'P ITY/STATE0P Stockton,CA 95202 <br /> CONTRACTOR Underground construction Co. { Q� PHONE 707-741-1761 <br /> CONTRACTOR ADDRESS 5145 Industrial Way CITYISTATEMP Benicia,CA 94510 <br /> SUBCONTRACTOR/CONSULTANT Corrpro Companies Inc.., PHONE 510-509-4993 <br /> SUBCONTRACTORICONSULTANT ADDRESS 2625c Barrington Court CITY/STATE/LP Hayward Ca 94545 <br /> TO <br /> LICENSE [C-57 _C-61 FI D-09 it Other NUMBER 764978 EXPIRATION DATE 06/30)2021 <br /> BILLING PARTY: OWNER ❑CONTRACTOR V/SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391)❑Dibromochloropropane(4392) 1 Arsenic(4393) <br /> INTENDED U Domestic/Private 0 Irrigation/Agricultural ❑Industrial n Water Quality Monitoring f'Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK NewWell �-i Replacement Well �7 Well Alteration/Modification Other cathodic protection well <br /> Monitoring Well(s) #of wells i Soil Bodng(s) #of borings i Geotechnical #of borings <br /> ❑Out-Of-Service Well C1 Out-Of-Service Well Renewal D Cross-Connection Repair <br /> _ New Pump ❑Pump Replacement ❑Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method VMud Rotary D Air Rotary Auger 11 Cable Tool ❑Push Point a Other <br /> Proposed Well Depth 61' ft Excavation 8.1 in diameter D Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickne`s�;/Gauge/ASTM Sched n Steel ❑Plastic Stainless Steel Other No casing <br /> Grout Seal DD th 20' ft �n Neat Cement(94 lb baa/5-10 oat water) ❑Sand Cement sack mixrl gal water <br /> 7 Bentonite(20%solids) ❑Other 20'-O'NEAT CEMENT <br /> Grout Placement Method Pumped 5 Free Fall Other Tremae Pipe ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By -Driller -i Pump Contractor n Other <br /> ❑Concrete Pedestal Dimensions:Width ft Length ft Thick in n Christy Box D Stove Pipe <br /> PUMP D Submersible Turbine 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. 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 48rHOUR <br /> ,,ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED b� S"'�^^'r' UV TITLE Construction Manager DATE 10/14/2019 <br /> U/N COUtf Jlr <br /> NMFNT NTy <br /> PgRTM-Nr <br /> M E N T U O Y d <br /> Application Accepted By ate Areae���%%// Employee ID# �V <br /> Grout Inspection By Date ❑ SPECIAL Well Penult <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount ate Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Request# <br /> EHD 43-08 8/112019L'_ I/ t/. /D/ 7E 7- WELL(PUMP PERMIT <br /> ,/ljlJ <br />