Laserfiche WebLink
DC-GB 0198 <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" 'American St .!1� Crrr/ZIp Stockton,CA.95204 m <br /> CROSS STREET E Sonoma Ave AP14 'd S-?I K L./0 PARCEL S¢E I LAND USE APPLICATION# o <br /> A <br /> m <br /> OWNER NAME Pacific Gas&Electric PHONE 1800-468-4743 <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 CITYISTATE/ZIP North Bend,WA 98045 <br /> SUBCONTRACTOR/CONSULTANT PHONE <br /> SUBCONTRACTORICONSULTANT ADDRESS CITYISTATEIZIP <br /> LICENSE XC-57 C-61 D-09 I Other NUMBER 1007649 EXPIRATION DATE 1-31-2021 <br /> BILLING PARTY: i OWNER XCONTRACTOR ll SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING:I I General Mineral/Coliform Bacteria(4391)1 1 Dibromochloropropane(4392)11 Arsenic(4393) <br /> INTENDED USE Domestic/Private LI Irrigation/Agricultural X Industrial [i Water Quality Monitoring I I Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner. Water System Name Contact Name or Phone Number <br /> TYPE OF WORK 11 New Well i1 Replacement Well I Well Alteration/Modification X Other Cathodic Protection <br /> D Monitoring Well(s) of wells II Soil Boring(s) #of borings D Geotechnical #of bonngs <br /> 0 Out-Of-Service Well D Out-Of-Service Well Renewal D Cross-Connection Repair <br /> D New Pump 0 Pump Replacement F. Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method 1 Mud Rotary D Air Rotary D Auger '.I Cable Tool D Push Point X Other Sonic <br /> Proposed Well Depth 49 ft Excavation 8 in diameter :1 Open Bottom X Gravel Pack/Gravel Size Coke in diameter <br /> I I Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter 2 in Thickness/Gauge/ASTM Sched X Steel 11 Plastic I I Stainless Steel 1 Other <br /> Grout Seal Depth 11 ft X Neat Cement(94 lb bag/,5-10 gal water) f 1 Sand Cement sack mix17 gal water <br /> Bentonite(20%solids) 'J Other <br /> Grout Placement Method X Pumped I I Free Fall "I Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By D Driller Pump Contractor Other <br /> [. Concrete Pedestal,.I Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP :. Submersibletl Turbine a 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-769 <br /> SIGNED TITLE Vice President DATE 4/15/2020 <br /> FC MFNT <br /> EI V FD <br /> PR 18 ?010 <br /> 04QUIN C <br /> N p NMENTqL TY <br /> EPq RTMENT <br /> DEPARTMENT USE ONLY <br /> �/ ' '1 .2C i o r o Area w SfJt'Kii7i"Em �:f• <br /> Applicafion Accepted By ,,` Date ployee ID# <br /> Grout Inspection By L�I��;Cu: Vn441 Date _ SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received h Amount Date Permit/ Invoice# Well ID# <br /> Codes Info ash Remitted ice Re uest# <br /> 371 ! #3t r <br /> EH043.06 6/11/2019 WELL/PUMP PERMIT <br />