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WELUPUMP PERMIT <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 EAST HAZELTON AVENUE-STOCKTON CA 95205.6232(206)466.3420 <br /> NON-REFUNDABLE PERMIT www.sjqov.org/ehd EXPIRES 1 YEAR FROM RATE ISSUED <br /> JOB ADDRESS 0 West weber Avenue :Nest bf JU0 CITYMP Stockton/95203 m <br /> West Washin ton St 145-190-150-000 S > <br /> CROSS STREET g APN PARCEL SIZE LLNO USE APPLICATION Is g <br /> OwNERNAME Stockton Cold Storage LLC C/O Michael J Mcnulty PxdNE (209)948-0793 <br /> OVINERADDRESS 1320 W Weber Avenue Cm1STATEIZ1P Stockton, CA 95203 <br /> CONTRACTOR Terracon Consultants, Inc. PHONE (949)864-2048 <br /> CONTRACTOR ADDRESS <br /> 1421 Edinger Avenue, Suite C CITY/STA7TIZIP Tustin, CA 92780 <br /> SUBCONIRACTORICONSULTANT 211 Drilling, Inc. PHONE (909) 490-0530 <br /> SUBCONTRACTORICONSULTANT ADDRESS 6939 Schaefer Ave CITYISTATEIZIP Chino, CA 91710 <br /> LICENSE XC-57 C-61 D-09 . Other NUMBER 709029 EXPIRATIONDATE 06/30/2021 <br /> SILLINOPARTY: OWNER XCONTRACTOR SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING:--General Mineral/Coliform Bacteria(4391)- Dibromochloropropane(4392) Arsenic(4393) <br /> INTEBDEOUSE DolnesticJPrivate -IRigaSon/Agricullural Industrial Water Quality Monitoring X Sol SampimglCharacterizalion <br /> Public Water System <br /> H eeNreM fnm W,n•r <br /> Wit.,Som.Name Contact Nems or PAsn•Nurnlfer <br /> TYPE OF WORK - New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Wells) s or wells Soil Boring(s) a et e6n"y6 X Geotechnical 4 e W eonnps <br /> Out-Or-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Proposed Well Depth 20 it Excavation 8 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter I Conductor Casing Depth h <br /> Wall Casing Diameter_in ThicknesalGaugelASTM Sched Steel Plastic Stainless Sleel Other <br /> Grout Seal Depth 20 it X Neat Cement(941b bagIS-10 gal wafer) Send Cement sack mixl7 gal water <br /> Benlonile(20%Solids) Other <br /> Grout Placement Method _ Pumped X Free Fall Other Retardant IAcceleralor(name) <br /> PEDESTAL Installed By Driller - PumpConlractor Other <br /> Concrete Pedestal _Dimensions.Width, It Length ftThick in Christy BOX L Stovepipe <br /> PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level it <br /> I HEREBY CERTIFY THAT 1 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 AA <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED <br /> �a LCclLILCL TITLE Orrice Manager DATE 7/13120 A <br /> /♦` <br /> N✓oU! 16 <br /> TNR�N//v <br /> pFfq�i q��TY <br /> MFA. <br /> I <br /> DEPARTMENT USE <br /> Application Accepted By L� �- ______ DatC? Area ,.(jµ,a"EmplOyee lDs_ <br /> Grout Inspection By s Date _ SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By DaleConstructed WCII Depth rt <br /> COMMENTS, f- f - S c,14 <br /> f0 VT <br /> P;peis pio•lte ,��, <br /> tb. -LOw i-O Iva! 0 be <br /> PE SC Received Cheeks/ Amount Dale Permltl Invoice s Well 106 <br /> Codas In ash Remitted 5 c Request 0 <br /> 1.EN04346 61tIM19 WELLMUMPPERMIT <br /> J 7� <br />