Laserfiche WebLink
1 <br /> DC-GB 0182 <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 Northwes Corner of Brandt Rd and'Sk ggs Ranch Rd CITY/ZIP Linden,CA.95236 an <br /> CROSS STREET Skaggs Ranch Rd APN/)Z� �Q'OU{{( PARCEL SIZE, 6(57ND USE APPLICATION N p <br /> OWNER NAME Pacific Gas&Electric PHONE 1800-468-4743 <br /> OWNER ADDRESS PO Box 997300 CITYISTATE/ZIP Sacramento,CA.95899 <br /> CONTRACTOR Gregory Drilling Inc. PHONE 425-869-2372 <br /> CONTRACTOR ADDRESS 14112452nd Ave SE CITY/STATE/ZIP North Bend,WA 98045 <br /> SUBCONTRACTOR/CONSULTANT PHONE <br /> SUBCONTRACTORICONSULTANT ADDRESS CITYISTATE/ZIP <br /> LICENSE X C-57 ❑C-61 CI D-09 U Other NUMBER 1007649 EXPIRATION DATE 1-31-2021 <br /> BILLING PARTY: U OWNER 9 CONTRACTOR ❑ SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING:❑General Mineral/Coliform Bacteria(4391)1.7 Dibromochloropropane(4392)D Arsenic(4393) <br /> INTENDED USE n Domestic/Private U Irrigation/Agdcullural X Industrial U Water Quality Monitoring U Soil Sampling/Characterization <br /> U Public Water System <br /> If different from Owner Water System Name Contact Name or Phone Number <br /> TYPE OF WORK D New Well U Replacement Well 0 Well Alteration/Modification X Other Cathodic Protection <br /> U Monitoring Wells) #of wells U Soil Boring(s) a of borings D Geotechnical ft of borings <br /> D Out-Of-Service Well 0 Out-Of-Service Well Renewal I:I Cross-Connection Repair <br /> L1 New Pump D Pump Replacement U Pump Repair tl Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method H Mud Rotary It Air Rotary LI Auger [I Cable Tool U Push Point IX Other Sonic <br /> Proposed Well Depth 200 It Excavation 8 in diameter 0 Open Bottom X Gravel Pack/Gravel Size Coke in diameter <br /> D Conductor Casing in diameter I Conductor Casing Depth ft <br /> Well Casing Diameter 2 in Thickness/Gauge/ASTM Sched X Steel 0 Plastic 0 Stainless Steel U Other <br /> Grout Seal Depth"ft X Neat Cement(94/b bag/5-10 gel water) D Sand Cement sack mixl7 gal water <br /> U Bentonite(20%solids) U Other <br /> Grout Placement Method X Pumped U Free Fall 0 Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By U Driller U Pump Contractor 0 Other <br /> [I Concrete Pedestal[)Dimensions:Width ft Length It Thick in U Christy Box U Stove Pipe <br /> PUMP U Submersibleo Turbine C Other HP Pump Set It Standing Water Level It <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 4B HOUR ADVANCE NOTICE REQUIRED FOR INSPEC'i IONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Vice President DATE 1/12/2020 <br /> AA/ 2 8 2020 <br /> Elt NVIAQUIN cou <br /> LTf R0 pgR MENTI' <br /> PA T MENT US <br /> Application Accepted By Dale Area Employee IO# <br /> Grout Inspection By 1_. Dale 7� ZL� PECIAL Well Permit <br /> Pump Inspection By Date _ WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth �K <br /> COMMENTS "� �'/LI 7�-44 ry 6 �1i,z 5 Ay�.1. /4 f-=��L 61 --�— vu-,- ' <br /> PE SC Received heckil/ Amount ate P°rmit/ Invoice# Well ID# `J v <br /> Codes Info as Remitted Service Request# <br /> uu>� - <br /> EHD43-06 6/11/2119 WELL(PUMP PERMIT <br />