Laserfiche WebLink
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.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> 5550 Cherokee Road CITY/LP Stockton,CA 95215 <br /> Virgil Street -B6Y OSD�J"01705 I PuQ� D <br /> CROSS STREET (3 APN ARCEL SIZE 14.97 aCfLAND USE APPLICATION#Zoning:AU-20 p <br /> A <br /> OWNER NAME Cherokee Freight Lines (Richard Damilano) PHONE (209)931-3570 w <br /> OWNER ADDRESS 5463 Cherokee Road CITY/STATE/ZIP Stockton,CA 95215 <br /> CONTRACTOR Geo-Ex Subsurface Exploration PHONE(916)799-8198 <br /> CONTRACTOR ADDRESS 1510 Madera Dr. CITY/STATE/Zlp Dixon,CA 95620 <br /> SUBCONTRACTOR/CONSULTANT Ninyo and Moore PHONE (408)829-9271 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS <br /> 2149 O'Toole Avenue,Suite#30 CITY/STATE/ZIP San Jose,CA 95131 <br /> LICENSE XC-57 C-61 0-09 Other NUMBER 954267 EXPIRATION DATE 7/31/2020 <br /> BILLING PARTY: OWNER _CONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) -Dibromochloropropane(4392)- Arsenic(4393) <br /> INTENDED U Domestic/Private Irrigation/Agricultural - Industrial Water Quality Monitoring Xsoil 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 Well(s) #of wells Soil Boring(s) #of borings XGectechnical 4 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 1 Mud Rotary Air Rotary XAuger I Cable Tool Push Point Other <br /> Proposed Well Depth up to 60 it Excavation 8 in diameter I Open Bottom i Gravel Pack/Gravel Size in diameter <br /> I Conductor Casing in diameter / Conductor Casing Depth it <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad Steel 1 Plastic Stainless Steel -1 Other <br /> Grout Seal Depth 60 ft 'v/Neat Cement(94/b bagl5-10 gal water) Sand Cement sack mixrl gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped Free Fall XOther Tremie _j Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length it Thick in :1 Christy Box J 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 /> MINIMU 4 H R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED „ Kenneth Celino TITLE Senior Staff Engineer DATE 6/16/2020 <br /> EENT <br /> l QEDor V <br /> 10,U/N <br /> PRT 6tv NTY <br /> A <br /> 6N 7- <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date fir'! .AO Area i Employee ID# DA <br /> Grout Inspection By Date -1 SPECIAL Well Permit <br /> Pump Inspection By Date I WAIVER Received <br /> Soil Boring Inspection B Date 'LG Constructed Well.D-e^pth ft <br /> COMMENTS be;S r(Af= Seart^s_ o TJ qA;),x /a� "Kir rx: ) �lV l—,ru Pip txL <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Cash Remitted a ice Rea uest# <br /> 7,21570 <br /> EHD 43-06 6/112019 � n �������7-� WELL/PUMP PERMIT <br />