Laserfiche WebLink
DC-GB 0184 <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 /> w <br /> JOB ADDRESS 2201 W Alpine Ave CIrY/ZIP Stockton,CA.95204 m <br /> Franklin Ave D <br /> CROSS STREET APN r�/�� PARCEL SIZE(l' LAND USE APPLICATION# o <br /> m <br /> m <br /> OWNER NAME Pacific Gas&Electric PHONE 1800-468-4743 m <br /> OWNER ADDRESS PO BOX 997300 CITY/STATE/ZIP Sacramento,CA.95899 <br /> CONTRACTOR Gregory Drilling Inc. PHONE 425-869-2372 <br /> CONTRACTOR ADDRESS 14112 452nd Ave SE CITY/STATE21P North Bend,WA 98045 <br /> SUBCONTRACTOR/CONSULTANT PHONE <br /> SUBCONTRACTOR/CONSULTANT ADDRESS CITY/STATE/ZIP <br /> LICENSE X C-57 ❑C-61 ❑D-09 D Other NUMBER 1007649 ExPIRATION DATE 1-31-2021 <br /> BILLING PARTY: D OWNER )(CONTRACTOR :: SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391), Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private a Irrigation/Agricultural X Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> If ddrerent from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well D Replacement Well ❑Well Alteration/Mociftation X Other Cathodic Protection <br /> Monitoring Well(s) #of wells ❑Soil Bonng(s) #of borings i Geotechnical #of borings <br /> Out-Of-Service Well 0 Out-Of-Service Weil Renewal U Cross-Connection Repair <br /> New Pump D Pump Replacement ❑Pump Repair U Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ::I Mud Rotary ❑Air Rotary i I Auger I I Cable Tool !,Push Point X Other Sonic <br /> r <br /> Proposed Well Depth206* 1 ft Excavation 8 in diameter 'J Open Bottom 11 Gravel Pack/Gravel Size in diameter <br /> I I Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched X Steel n Plastic I!Stainless Steel 'I Other <br /> Grout Seal Depth gjb /,Z ft X Neat Cement(94 Ib bag15-10 gal water) 11 Sand Cement sack mix/7 gal water <br /> D Bentonde(20%solids) X Other Coke Breeze <br /> Grout Placement Method X Pumped D Free Fall I Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By n Driller S Pump Contractor ❑ Other <br /> ❑Concrete Pedestal -i Dimensions:Width ft Length ft Thick in Christy Box . Stove Pipe <br /> PUMP G 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 /> MIN IMI{IM 48 HOUR ADVANCE NOTICE RE_QUIREn FOR INSPFCTIONS-Pf..FASF CAI I_(?09)953-7697 <br /> SIGNED a: '��. TITLE Vice PresidentDATE 1/12/2020 <br /> AYMENT <br /> ECEIVE® <br /> N 2 8 Z�ZJ <br /> OAQUIN COUNTY <br /> -iiISWIRONMENTAL <br /> [iEAl H QERARTMENT <br /> A 'TMENT USE ONLY <br /> i �J <br /> Application Accepted By Date Area v G Employee ID#jL;;� — <br /> Grout Inspection By 7 Date L;�'(J 0 ell Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Iion B Date Constructed Well Depth ft <br /> !1`I t ,,,t q7, <br /> COMMENTS IYtP:�!L Pf' ZOc'D �i�G1^rfti'I/',IFf I/•' r r�7Jt/,� sem"/ F(y r4 <br /> PE SC Received Chec Amount Permit' Invoice M Well IDM <br /> Codes Info emitted *ta Service Request# <br /> y rl`y <br /> LHD43-06 6/1112019 <br /> W LLL iPUMP PLRMIr <br />