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0 0 <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 /> N <br /> JOB ADDRESS 25460 South Schulte Road CITY/ZIp Tracy,CA 95377-9709 m <br /> D <br /> CROSS STREET Mountain House Parkway APN 209-440-35 PARCEL SIZE 2 acres LAND USE APPLICATION#NA z <br /> m <br /> OWNER NAME Jacab Corporation H <br /> PHONE <br /> OWNER ADDRESS 25460 South Schulte Road CITYISTATEIZIP Tracy,CA 95377 <br /> CONTRACTOR Gregg Drilling PHONE (925)313-5800 <br /> CONTRACTOR ADDRESS 950 Howe Road CITYISTATEIZIP Martinez,CA 94553 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/$TATEIZIP <br /> LICENSE -C-57 C-61 D-09 Other NUMBER 485165 EXPIRATION DATE 1/31118 <br /> GEOGRAPHICAL INFORMATION: Coordinates X 37.72295 y-121.53198 Township 2S Range 4E Section 28 <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> If different from OwnerWa er System Name ntacf Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Wells) #of wells -Soil Boring(s) 12 of borings Geotechnical #eft100ngs <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tool -ush Point Other <br /> Proposed Well Depth 20 it Excavation 2 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth R <br /> Well Casing Diameter_ in Thickn�ess/(Gauge/ASTM Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 20 ft 7N,at Cement(94.lb bag.15-10 gal water) Sand Cement sack mix17 gal Water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method i Pumped;7Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width—ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set R 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. 1 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 /> M IMUM H UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS- PLEASE CALL(209)953-7697 <br /> SIGNED on behalfInc. TITLE Project Manager DATE 7126117 <br /> lIli Ilk a. <br /> P A <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee lD#—A <br /> Grout Inspection By Date _ S ECIAL WeII Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Chadd{! Amount Date PermlU Invoice# Well Codes Info B Cash Remitted Service Request# <br /> 9371 150 -M yah <br /> EHD 43-06 WELL/PUMP PERMIT <br /> 4/30/12 <br />