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WELL/PUMP PERMIT-WELL#2 <br /> - SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 - -' <br /> NON-REFUNDABLE PERMIT www.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS Adjacent to 12988 Neugebauer Road WELL#2 (GPS:37.978806,-121.472772) CITY2IP Stockton CA 95206 <br /> D <br /> CROSS STREET McDonald River Bridge APN 1310202 t PARCEL SIZE • LAND USE APPLICATION# A <br /> OWNER NAME City of Stockton KI LAC-"/ PN721er-C ��LL PHONE w <br /> OWNER ADDRESS City Hall,425 N,EI Dorado St 4 53 ]��Y•ar trJS�AA� 417Y/STATEZP Stockton,CA 95202 <br /> Underground construction Co. IYlL[I'IVL� 707-741-1761 <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS 5145 Industrial Way CITY/STATEZP Benicia,CA 94510 <br /> SUBCONTRACTORICONSULTANT Conpm Companies Inc.., PHONE 510-509-4993 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 2625c Barrington Court CITY/STATEZP Hayward Ca 94545 <br /> LICENSE 1C-57 C-61 D-09 LI Other NUMBER 764576 EXPIRATION DATE 06130/2021 <br /> BILLING PARTY: OWNER D CONTRACTOR ,/SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:❑General Mineral/Coliform Bacteria(4391)1,Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE D DomesticlPrivate D Irrigation/Agricultural ❑Industrial D Water Quality Monitoring a Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well 1 Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells u Soil Boring(s) #of borings r i Geotechnical #of borings <br /> D Out-Of-Service Well D Out-Of-Service Well Renewal D Cross-Connection Repair <br /> D New Pump 1 Pump Replacement U Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method VMud Rotary D Air Rotary el Auger Cable Tool Push Point D Other <br /> Proposed Well Depth 61' ft Excavation 81, in diameter Open Bottom ViGravel Pack/Gravel Size id diameter <br /> -i Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thidmes�/Gauge/ASTM Schad D Steel 11 Plastic D Stainless Steel Other No casing <br /> Grout Seal ,Dth_20' ft Neat Cement(94 lb bag/5-10 gal water) D Sand Cement sack mixf7 gal water <br /> Kentonite(20%solids) D Other 20'-0'Neat Cement <br /> Grout Placement Method ❑Pumped ❑Free Fall Other TREMIE PIPE D Retardant/Accelerator(name) <br /> PEDESTAL Installed By D Driller D Pump Contractor D Other <br /> D Concrete Pedestal DDimensions:Width ft Length ft Thick in D Christy Box D Stove Pipe <br /> PUMP D Submersible Turbine D 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 4��8/HOUR <br /> �ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED -bayLd saa4 uf, TITLE Construction Manager DATE 10114/2019 <br /> RA YiWE�1T <br /> NOV 2 7 2010 <br /> JOAQUIN CpU <br /> TWD pARVV7RONMeN N7Y <br /> P_A M E N T U E O Ly A <br /> Application Accepted By ate Area `� Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <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 Pennitl <br /> odes Ifo Cash emitted J. <br /> ate Service Re uest# Invoice# Well ID# <br /> LM V <br /> 040 3 <br /> EHD43-M 6/112019 l�'Y• WELLIPUMPPERMIT + <br />