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t 1. <br /> WELL/PUMP PERMIT <br /> .SAN JOAOUIN 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 /> Joe ADDRESS Terminal,205 Port Road I Cirv2iP Stockton m <br /> $ <br /> CROSS STREET Harbor Street ApN 14502004 PARCEL SIZE 162 ac LAND USE APPL1WT10N# <br /> Lehigh CernentX800-821-9119 <br /> OWNER NAME <br /> OWNER ADDRESS ' <br /> I erminal,_05 Port Road 1 CITYISTATE/ZW Stockton,CA 95203 <br /> CONTRACTOR <br /> Geocon Consultants,Inc. PHONE 916-852-9118 <br /> CONTRACTOR ADDRESS 3160 Gold Valley Drive,Suite 800 CttYISTATEIZP Rancho Cordova,CA 95742 <br /> SUBCONTRACTOwCONSUITANT <br /> Middle Earth Geo Testing,Inc. PHONE 714-633-5025 <br /> SUBCONTRACTORJCONsuLTANT ADDRESS 954 Forth Lemon Street CRYISTATEIZIP Orange,CA 92867 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 899-151 ExPutmmDATE 6/30/2021 <br /> BILLING PARTY: OWNER XCONTRACTOR SUBCONTRACTORJCONSULTANT <br /> DOMESTIC WELL SAMPLING: _ General MinerabCohform Bactena(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE DOme5bcphvate Irngabon,Agncuftural Industrial Water Quality Monitoring X Soil Sampling7Charaeterizatlon <br /> Public Water System <br /> M eelMnt 001 0.— Water SysMm Nerre cattact N—or Prone Nimlear <br /> TYPE OF WORK I New Well Replacement Well Well Alteration/Modification X Other CPT Sounding <br /> -1 Monitoring Wells) #of wells Soil Bonng(s) a of borings -Geotechnical I e or xr ops <br /> Out-OfSennce Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> J New Pump Pump Replacement G Pump Repair Raise Well Casing <br /> WELL CON5TRVCTION <br /> Drilling Method Mud Rotary As Rotary Auger Cable Tod Push Point x DOW, DILrCt push <br /> Proposed Well Depth 70 ft Excavation 4 ir,diameter Open Bottom D Gravel PacklGravel Size in diameter <br /> Conductor Casing in diameter I Conductor Casirg Depth ft <br /> Well Casing Diameter in ThtcitnesslGauge/ASTM Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Deptr_ � It X Neat Cement(94 lb baVS-10 gal.eater) Sand Cement sack mx.lr gal water <br /> Bc-tonne(20%solids) Other <br /> Grout Placement Method Pumped Free Fall Other Retaroa-:t/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Otner <br /> Concrete Pedestal Dimensions:Width ft Lenqtn R T^Ce in Christy Bos Stove Pipe <br /> Puwo <br /> Su:)-lers,bie Turbine Other HP PL,'p Se: ii Star:t ng LCater Level fl <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 /> CURRENJAND CTIVE WITH THECALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALLWORKERNS TION LA)NS. <br /> M 11UADVANCE NOTICE QUIRED F'O1R INSPECTIO S- LEASE(CALL(209))953-7697 <br /> SIGNED TmP/-tf�i1l-lLl.i� �'lL �D_� L�►�(, J—��/' l)Z v <br /> Y <br /> FMFNr <br /> vFo <br /> ?o?o <br /> O <br /> COU�yTy <br /> FNT <br /> �/ CTJ• D E�P;LIA�RTMENT USE aMt 1 <br /> Apphcetion Accepted By ll�—tel /'✓✓�/C- Doak, � Z� ZiOL� Area t S IJi K fJ:T Employee ID# -SCD 01 lrt l! <br /> Grout Inspection By Dow SPECIAL Well Permit <br /> Pump Inspection ByDale WAIVER Received <br /> Soft Boring Inspection By Dale L! / L_wit/ Conatructad Well Depth fl <br /> COMMENTS <br /> PE SC Received CheCkV Amount Perrn.0 Invoice M Well IOM <br /> Codes Info ash Remttw Dab Service Ra ust a <br /> L 37a ISS 44S6 PC 0 410W) <br /> PH:: <br /> EnD43-06 6112019 WELL HUMP PERMIT <br />