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WELL/PUMP PERMIT <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/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Ln <br /> JOB ADDRESS 7850 R A Bridgeford <br /> CITv/ZIP Stockton/95206 m <br /> a <br /> CROSS STREET Earhart Ec B APN 17 7 2 6 0 3 4 PARCEL SIZE 7 2 0 LAND USE APPLICATION# o <br /> A <br /> OWNER NAME Stockton Metropolitan Airport PHONE ui <br /> OWNER ADDRESS 5000 S Airport Way CITY/STATE/ZIP Stockton/CA/95206 <br /> CONTRACTOR V&W Drilling PHONE (2 0 9) 469-7700 <br /> CONTRACTOR ADDRESS 1133 Blackhurst Drive CITY/STATE/ZIP Galt/CA/95632 <br /> SUBCONTRACTORICONSULTANT Kl e inf elder PHONE (2 0 9) 948-1345 <br /> SUBCONTRACT�OR/CONSULTANTADDRESs 2001 Arch Airport Rd CITY/STATE/ZIP Stockton/CA/95206 <br /> �?S. <br /> LICENSE C-57 C-61 I D-09 ❑ Other NUMBER 720904 EXPIRATION DATE 4/30/2020 <br /> BILLING PARTY: OWNER CONTRACTOR :XISUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural �i Industrial ! Water Quality MonitoringSoil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK I New Well Replacement Well J Well Alteration/Modification 0 Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings Geotechnical 11 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal ❑ Cross-Connection Repair <br /> New Pump Pump Replacement n Pump Repair ❑ Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary 7 Air Rotary `Auger ❑ Cable Tool Push Point ❑ Other <br /> Proposed Well Depth 5-3 0 ft Excavation 6 in diameter Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched I! Steel I I Plastic -! Stainless Steel i I Other <br /> Grout Seal Depth ft _j Neat Cement(94 Ib bag/5-10 gal water) I I Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) 11 Other <br /> Grout Placement Method X Pumped i 1 Free Fall D Other Tremie Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller 1-1 Pump Contractor CI Other <br /> Concrete Pedestal i-IDimensions:Width ft Length ft Thick in 0 Christy Box ❑ Stove Pipe <br /> PUMP L-:i Submersible.-.] Turbine i-1 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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL(209) 953-7697 <br /> SIGNED j��' ` TITLE Staff Professional DATE 4/8/2020 <br /> r <br /> D <br /> J <br /> E R0NWa UNTy <br /> A T <br /> T <br /> DEPARTMENT SE ONLY /� <br /> Application Accepted By /�' Date y �`J� 2�=�C Area � '"O�1 Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By oe 4 Date WAIVER Received <br /> Soil Boring Inspection By r Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B C sh Remitted Service Request# <br /> 11 37a Iso 1'3% 1-1.20 w P 0 0 L4 0-+ <br /> EHD 43-06 6/11/2019 /n /" �j/���G� WELL/PUMP PERMIT <br />