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c <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 0`70.) _E. Fi.)1 777 CrrYmP(� Galt, 95632 m <br /> CROSS STREET Highway 99 APN 00502005 PARCEL SIZE1 19aC LAND USE APPLICATION# z <br /> OWNER NAME Chris P. Choe PHONE y <br /> OWNER ADDRESS 809 Crystal Way CRY/STATE21P Galt,CA 95632 <br /> CONTRACTOR Geocon Consultants,Inc. p PHONE <br /> CONTRACTOR ADDRESS 3160 Gold Valley Drive, Suite 000 CIN/STATE/ZIP Rancho Cordova,CA 95742 <br /> SUBCONTRACTOR/CONSULTANT V&W Drilling,Inc. PHONE 209-469-7700 <br /> (,a <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 1133 Blackhurst Drive CITY/STATE/ZIP `-"lt,CA 95632 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 720904 EXPIRATION DATE <br /> BILLING PARTY: OWNER CONTRACTOR SUBCONTRACTOR/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 Soil 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 C Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #Of borings gGeolechni-at 2 a of borings <br /> I Out-Of-Service Well Out-Of-Service Well Renewal '_Cross-Connection Repair <br /> 1 New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method '-1 Mud Rotary Air Rotary X Auger Cable Tool Push Point x Other dynamic cone penetrometer <br /> Proposed Well Depth 70 ft Excavation 8" 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 Plastic Stainless Steel Other <br /> Grout Seal Depth 70 ft ;L Neat Cement(94/b bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped 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 Standinq 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. 1 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 /> M 48 H=E CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ---.-. ✓_ - T,TLE Sr. Staff Engineer DATE 7/31/2020 <br /> CENT <br /> EIfVFt) <br /> �G 0 ?020 <br /> ri-M.104QUI <br /> V D P. N°AL TY <br /> - gRTMENT <br /> DEPARTMENT U.SSE ONLY <br /> Application Accepted By �� Date Area qEm Employee y <br /> ee ID# <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date [IWAIVER Received <br /> n� <br /> Soil Boring Inspection By Date 020 4� Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received ec / Amount Date Permit/ Invoice# Well ID# <br /> Codes Info HVj Cash Remitted Service Request# <br /> Vq <br /> EHD43-06 6,1112019 WELL JPUMPPERMIT <br /> ))dCI6111b <br />