Laserfiche WebLink
WELLIPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 7-31 Carlton Way CITY/ZIP Tracy, CA 95376 m <br /> CROSS STREET Madison Avenue APN 23216008 PARCEL SIZE_)O r 7 LAND USE APPLICATION# <br /> OWNER NAME Tracy Unified School District PHONE 209-830-3200 y <br /> OWNER ADDRESS 1875 W Lowell Avenue CITY/STATE/MP Tracy, CA 95376 <br /> CONTRACTOR Baia Exploration PHONE 760-743-7678 <br /> CONTRACTOR ADDRESS 1915 Commercial Street c,TY/sTATErzIP Escondido, CA 92029 <br /> SUBCONTRACTOR/CONSULTANT BSK Associates PHONE 916-853-9293 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 3140 Gold Camp Dr.#160 CITY/STATE/ZIP Rancho Cordova, CAA 95670 <br /> LICENSE X C-57 C-61 D-09 -i Other NUMBER 804318 EXPIRATION DATE 02/28�2022 <br /> BILLING PARTY: _OWNER 'J CONTRACTOR X SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING: .General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private 7 Irrigation/Agricultural = Industrial Water Quality Monitoring X Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner. Water System Name Contact Name or Phone Number <br /> TYPE OF WORK U New Well -i Replacement Well E Well Alteration/Modification U Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings X Geotechnical�_#of borings <br /> Out-Of-Service Well C Out-Of-Service Well Renewal E Cross-Connection Repair <br /> New Pump U Pump Replacement 7 Pump Repair ❑Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary I Air Rotary X Auger Cable Tool 7 Push Point Other <br /> Proposed Well Depth 15 ft Excavation 6-8 in diameter -1 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 Schad U Steel =Plastic Stainless Steel U Other <br /> Grout Seal Depth 15 ft X Neat Cement(94 Ib bag/5-10 gal water) I Sand Cement sack mix/7 gal water <br /> -Bentonite(20%solids) Other <br /> Grout Placement Method Pumped X Free Fall Other ❑Retardant/Accelerator name <br /> Installed By ❑Driller Pump Contractor - Other <br /> I Concrete Pedestal (Dimensions:Width ft Length ft Thick in i Christy Box i I 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 /> rMINIMUM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED -7— TITLE mer DATE 7/27/2020 <br /> RF YMFNT <br /> CE jVtD <br /> JUL 30 ?0?0 <br /> U1 COU/0-11 <br /> rH 61V <br /> ARTMENT <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date OOZI� Area /GXW111 <br /> Employee ID# <br /> Grout Inspection By Date SPECPermit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date / Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Chec AmountDate Permit/ Invoice# Well ID# <br /> Codes Info ash Remitted Se,vic Re uest# <br /> EHD 43-06 6/11/2019 WELL/PUMP PERMIT <br />