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c r ' <br /> WELL/PUMP PERMIT <br /> • SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 6800 EI Dorado Street CrrYZP San Joaquin County,CA <br /> a <br /> CROSS STREET French Camp Road APN Jf �O O PARCELSIZE7T.1/ LAND USE APPLICATION# A <br /> m <br /> OWNER NAME Newport Carriers IncPHONE 510-779-6644 N <br /> OWNER ADDRESS 26228 Industrial Boulevard -/STATEIZIP Hayward,CA 94545 <br /> CONTRACTOR <br /> Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue Cm/STATE/Z1P Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CrrY/STATE/LP Clovis,California 93612 <br /> LICENSE /C-57 D C-61 ❑D-09 D Other NUMBER 499908 ExPIRATION DATE 10.31.2018 <br /> DOMESTIC WELL SAMPLING:Fj General Mineral/Coliform Bacteria(4391)C Dibromochloropropane(4392)L.i Arsenic(4393) <br /> INTENDED USE n Domestic/Private n Imgation/Agricultural n Industrial ❑Water Quality Monitoring n Soil Sampling/Characterization <br /> n Public Water System <br /> If diRerent from Owner Water System Name Contact Name or Phone Number <br /> TYPE OF WORK a New Well D Replacement Well n Well Alteration/Modification '.I Other <br /> n Monitoring Well(s) #of wells ft Soil Borings) *°f b0"ro' ./�Geotechnical 6 #ot bo gs <br /> L'Out-Of-Service Well -1 Out-Of-Service Well Renewal G Cross-Connection Repair—(TII 50Feet) <br /> ❑New Pump D Pump Replacement :!Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method n Mud Rotary p Air Rotary 4f Auger C Cable Tool ❑Push Point n Other <br /> Proposed Well Depth jo' sJ It Excavation in diameter ❑Open Bottom 'Gravel Pack/Gravel Size in diameter <br /> ❑Conductor Casing in diameter / Conductor Casing Depth It <br /> Well Casing Diameter in t hickness/Gauge/ASTM Schad D Steel r l Plastic i_i Stainless Steel o Other <br /> Grout Seal DepthI 6��ft .(Neat Cement(94 lb bagl5-10 gal water) ❑Sand Cement sack mix/7 gal water <br /> .1 Bentonite(20%solids) i I Other <br /> Grout Placement Method E.Pumped Ll Free Fall V Other j Retardant/Accelerator(name) <br /> PEDESTAL Installed By D Driller D Pump Contractor Other <br /> Concrete Pedestal❑Dimensions:Width ft Length ft Thick in D Christy Box ❑Stove Pipe <br /> PUMP c Submersible❑Turbine D Other HP Pump Set It Standing Water Level ft <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 <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HO ADyA NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIONEEL <br /> TITLE Managing Engineer DATE 03/27/2019 <br /> NT <br /> I Lk <br /> Q <br /> 2019 <br /> COUNTY <br /> MENT <br /> 1 #1 <br /> PA TMENT U E NLY <br /> Application Accepted By a Date Area— Employee ID#j4r#&V <br /> Grout Inspection By Date � SPECIAL Well Penmit <br /> Pump Inspection By Date 2 1: WAIVER Received <br /> Soil Boring Inspection By Date Z 7 Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Che Amount Permit/ <br /> odes Info ash Remitted Date Service Re uest# Invoice Al Well ID# <br /> EHD 43-08 rev,see 4114118 WELL/PUMP PERMIT <br />