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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 WNnN.s ov.Or_c/ehd EXPIRES 1 YEAR_FROM_DA_TE ISSUED <br /> JOB ADDRESS Sharpe Army Depot,850 Roth Road CITYMP Lathrop/95231 <br /> CROSS STREET S.Airport Way APN 198-02-001 _ 351 A� D <br /> PARCEL SIZE ND t1SE APPLICATION#_ <br /> OWNER NAME Sharpe Army Depot PHONE tr? <br /> OWNER ADDRESS 850 Roth Road CITY/STATE/ZIP Lathrop/CA/95231 <br /> CONTRACTOR V&W Drilling,Inc. PHONE 209-369-9600 <br /> CONTRACTORAOOREss 1133 Blackhurst Drive CITYISTATE/ZIP Galt/CA/95632 <br /> SUBCONTRACTOR/CONSULTANT Mid Pacific Engineering,Inc. PHONE 916-927-7000 <br /> SUBCONTRACTORICONSULTANTADORESS 840 Embarcadero Drive Cm/STATEIZ1PWest Sacramento,California 9560 <br /> LICENSE EY C-57 C C-61 0 D-09 C Other NUMBER 720904 EXPIRATION DATE <br /> BILLING PARTY: D OWNER ❑CONTRACTOR 9 SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:C General Mineral/Coliform Bacteria(4391)D Dibromochloropropane(4392)C Arsenic(4393) <br /> INTENDED USE ❑Domestic/Private 7 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring 3 Soil Sampling/Characterization <br /> 0 Public Water System <br /> If different from Owner. Water System Name Contact Name W Phone Number <br /> TYPE OF WORK ❑New Well ❑Replacement Well C Well Alteration/Modification ❑Other <br /> 0 Monitoring Weil(s) #of wells D Soil Boring(s) x of bedr9s ❑Geotechnical 3 N of borings <br /> 0 Out-Of-Service Well C Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> 0 New Pump 0 Pump Replacement 0 Pump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 0 Mud Rotary 0 Air Rotary M Auger 3 Cable Tool 0 Push Point 0 Other <br /> Proposed Well Depth 15-50 ft Excavation 8 in diameter 0 Open Bottom D Gravel Pack/Gravel Size in diameter <br /> 0 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_In Thickness/Gauge/ASTM Sched 0 Steel ❑Plastic 3 Stainless Steel ❑Other <br /> Grout Seal Depth 15-50 ft XNeat Cement(94/b bagl5-10 gal water) 0 Sand Cement sack mixl7 gal water <br /> 0 Bentonite(20%solids) C Other <br /> Grout Placement Method (KPumped ❑Free Fall 0 Other ❑Retardant I Accelerator(name) <br /> PEDESTAL Installed By ❑Driller 0 Pump Contractor ❑ Other <br /> 0 Concrete Pedestal❑Dimenslons:Width ft Length ft Thick in ❑Christy Box C Stove Pipe <br /> PUMP 0 Submersible❑Turbine 0 Other HP Pump Sel 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 COtiI lf*ATION LAWS. <br /> MI UM 48 HO �AN E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE 5'61 DATE <br /> r I <br /> Li IENT <br /> ( I EIVED <br /> 12020 <br /> JOAQUIN COUNTY <br /> IRONMENTAL <br /> I I Ty DEPARTMENT <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area j 7 Employee ID# 5'` <br /> Grout Inspection By Date 7 SPECIAL Well Permit <br /> Pump Inspection By Date C WAIVER Received <br /> Soil Boring Inspection By k, a— OAAA_-A_- Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes I f I Remitted Service Roque # <br /> 7.� rSo •o 51tikA <br /> i <br /> EHO 43.06 6/11/2019 WELL IPUMP PERMIT <br />