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T <br /> 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 /> JOB ADDRESS 1243 W.March Lane CITY/ZJP Stockton,CA y <br /> CROSS STREET N.Pershing Ave APN 108-16010 PARCEL SIZE r LAND USE APPLICATION# o <br /> A <br /> OWNER NAME BP Products North America,Inc.(BP) PHONE 630-379-7617 <br /> OWNER ADDRESS 150 W.Warrenville Road,Bldg.605,3rd Floor CITY/STATE/ZIP Naperville,Illinois 60563 <br /> CONTRACTOR PSI-Intertek PHONE 510-434-9200 <br /> CONTRACTOR ADDRESS 4703 Tidewater Ave CITY/STATE/ZIP Oakland,CA 94602 <br /> SUBCONTRACTOR/CONSULTANT Britton Exploration PHONE 408-355-5781 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 23051 Evergreen Land CITY/STATE/ZIP Los Gatos,CA 95033 <br /> LICENSE .�C-57 --C-61 I. D-09 __ Other NUMBER 849905 EXPIRATION DATE 11/30/2020 <br /> BILLING PARTY: Ll OWNER X CONTRACTOR D SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING:U General MineraUColiform Bacteria(4391)-`Dibromochloropropane(4392)C.Arsenic(4393) <br /> INTENDED USE i!Domesfic/Private I Irrigation/Agricultural n Industrial ❑Water Quality Monitoring R Soil Sampling/Characterization <br /> Public Water SystemZach Jaco 510-306-5717 <br /> If different from Omer. Water System Name Contact Name or Phone Number <br /> TYPE OF WORK c New Well Replacement Well :J Well AlterationlModification L Other <br /> CI Monitoring Well(s) #of wells ri Soil Boring(s) #or borings R Geotechnical 9 a of borings <br /> D Out-Of-Service Well 5 Out-Of-Service Well Renewal D Cross-Connection Repair <br /> CI New Pum L,Pump Replacement =]Pump Repair :j Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method D Mud Rotary 0 Air Rotary tit Auger L1 Cable Tool D Push Point - Other <br /> Proposed Well Depth 8 D_S0 It Excavation in diameter a Open Bottom ❑Gravel Pack/Gravel Size in diameter <br /> D Conductor Casing in diameter / Conductor Casing Depth It <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched '7 Steel 7 Plastic D Stainless Steel Other <br /> Grout Seal Depth_1 D—Y0 ft to Neat Cement(94 Ib bag/5-10 gal water) Li Sand Cement sack mixR gal water <br /> . Bentonite(20%solids) Other <br /> Grout Placement Method Pumped g Free Fall Other r Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller D Pump Contractor Other <br /> Concrete Pedestal DDimenslons:Width ft Length It Thick in ?Christy Box _;Stove Pipe <br /> PUMP = Submersible-,Turbine D Other HP Pump Set It 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 AC ITH THE C IFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMP TI LAWS <br /> MI TICE REQUIRED FOR IN�SPEyC.TI/O1N�S�PL�E/A1SE CALL(209y)�9 3-76 7 <br /> SIGNED w TITLEW*3`E_C DATE 1 L <br /> RE yMF <br /> qV�� <br /> a pR 2? <br /> ?0?0 <br /> H�Fpq COO <br /> DEPARTMENT S ONLY t� <br /> Application Accepted By!-� �� Dale q Z/ Z-0 7-0 Area s -k"�N Employee ID# S~ <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By �1 Date I I WAIVER Received <br /> Soil Boring Inspection By AALI'47 //� Dates 7 20"z42 Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#( Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Cash Remitted Servi e (equits <br /> 7a 0 7d <br /> EHD 43-06 6/11Ra19 J D41,077,9312-1, WELL/PUMP PERMIT <br />