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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 /> JOB ADDRESS Zuckerman Road Approx 2400 North of%,IcDonald River Bridge CITYIZIP Stockton.CA <br /> CROSS STREET/ C O^G• O PARCEL SIZE J LLAND USE APPLICATION# p <br /> m <br /> or <br /> OWNER NAME PG&E PHONE re <br /> OWNER ADDRESS 1181 Zuckerman Road CITY/STATE/ZIP Stockton,CA <br /> CONTRACTOR Krazan&Associates.Inc. PHONE 559 3481200 <br /> CONTRACTORADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis,California 93612 <br /> SUBCONTRACTOR Kratan&ASSOciale5,Ir1C. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis.California 93612 <br /> LICENSE JC-57 C-61 D-09 Other NUMBER 49998 EXPIRATION DATE 10.31.2020 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring 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 Replacement Well Well Alteration/Modification Other <br /> Monitoring Wells) #of wells Soil Bohng(s) n of borings �f Geotechnical 2 4 of bonngs <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair (10-50 Feet) <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary V Auger Cable Tool Push Point Other <br /> Proposed Well Depth It Excavation 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 Steel Plastic ,Stainless Steel Other <br /> Grout Seal Depth ft ./Neat Cement(94/b bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length It Thick in Christy Box Stove Pipe <br /> PUMP 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 /> NPUILUM 48 HO D CE TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SI9NBD�—i TITLE Managing Engineer DATE 03/05,12020 <br /> FENT <br /> I vtb <br /> 132020 <br /> MENTUNTy <br /> ARTMLNT <br /> DEPARTMENT USE ONLYIle <br /> y t <br /> Application Accepted By �A� C6� Date -2 IZOZO Area -3 �i�/ Employee ID# -��'��d•ilt't'/ <br /> Grout Inspection By Date PECIAL Well Permit <br /> Pump Inspection By Date 7� WAIVER Received <br /> Soil Boring,InspectionrBy Date vv Constructed Well Depth ft <br /> COMMENTS 41+8 �'7 , /eYMI I Pl' c,r'Q �✓f C i '! he-Yt 3 Ceet <br /> acg r I's fiiisw-f it The bzrehae <br /> PESC Received r Checktli Amount Permit/ Invoice# Well ID# <br /> Codes Info Remitted ate Service Re uest# <br /> y 7d Iso �u D U <br /> EHD 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />