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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 www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2510 S Hwy 99 Frontage Rd (APN 171-300-240) CITY/ZIP Stockton 95205 m <br /> D <br /> CROSS STREET Mariposa Rd APN 171-300-240 PARCEL SIZE 2.0 acres LAND USE APPLICATION# A <br /> OWNER NAME James Blincoe Trust PHONE <br /> OWNER ADDRESS 14501 Wells Ln CITY/STATE/ZIP Lodi, CA 95240 <br /> CONTRACTOR Cascade Drilling PHONE 209-570-7235 <br /> CONTRACTOR ADDRESS 3000 Duluth St CITY/STATE/ZIP West Sacramento, CA 95691 <br /> SUBCONTRACTOR/CONSULTANT Antea Group PHONE 651-697-5114 <br /> SUBCONTRACTOR/CONSULTANTADDRESS 11010 White Rock Rd, Ste. 140 CITY/STATE/ZIP Rancho Cordova, CA 95670 <br /> LICENSE X C-57 ❑ C-61 D-09 ❑ Other NUMBER 1058336 EXPIRATION DATE 9/30/2021 <br /> BILLING PARTY: ❑OWNER ❑CONTRACTOR XSUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:❑General Mineral/Coliform Bacteria(4391)❑ Dibromochloropropane(4392)❑Arsenic(4393) <br /> INTENDED USE ❑ 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 XSoil Boring(s) X 13 #of borings ❑ Geotechnical #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 ❑ Mud Rotary ❑ Air Rotary ❑ Auger ❑ Cable Tool ❑ Push Point X Other Direct push Geoprobe <br /> Proposed Well Depth 18 ft Excavation 2 in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br /> ❑ Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_ in Thickness/Gauge/ASTM Sched ❑ Steel F1Plastic ❑ Stainless Steel ❑ Other <br /> Grout Seal Depth 18 ft X Neat Cement(94 lb bag/5-10 gal water) ❑ Sand Cement sack mixl7 gal water <br /> ❑ Bentonite(20%solids) ❑ Other <br /> Grout Placement Method ❑ Pumped X Free Fall ❑ Other ❑ Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br /> ❑ Concrete Pedestal❑Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL(209) 953-7697 <br /> SIGNED Ian Treat TITLE Project Professional DATE 5/5/2020 <br /> N <br /> MAR -5 in6n I <br /> NVI aryl ENT NT <br /> RTVENT <br /> _Fff7 <br /> DEPARTMENT USE ONLY <br /> Application Accepted By ZZ— Date S # ZC?zo Area //p Cf Employee ID# 5 k <br /> Grout Inspection By_ Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By5�1�i-1/ Date �Z� Constructed Well Depth t ft <br /> COMMENTS 1 �' CJmDre Yl O P rah i f D ID n / <br /> V10 permi����/ <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Request# <br /> 43�d is,, S l6, I <br /> D <br /> 0 <br /> EHD 43-06 6/11/2019 /• r fr �q 3s -N 13 WELL/PUMP PERMIT <br />