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,r 1 <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.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> U) <br /> JOB ADDRESS 10055 CA-99 (Stockton Soccer Complex) CITY/ZIP Stockton, CA 95212 m <br /> D <br /> CROSSSTREET Waller Road APN 12202009 PARCEL SIZE37.9 acLAND USE APPLICATION# A <br /> m <br /> OWNER NAME City of Stockton PHONE 209-830-3200 <br /> OWNER ADDRESS 425 N EI Dorado Street CITYISTATE/7JP Stockton, CA 95202 <br /> CONTRACTOR Baia Exploration PHONE 760-743-7678 <br /> CONTRACTOR ADDRESS 1915 Commercial Street CITY/STATE/ZIP Escondido, CA 92029 <br /> SUBCONTRACTOR/CONSULTANT BSK Associates PHONE 916-853-9293 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 3140 Gold Camp Dr.#160 CITY/STATE21P Rancho Cordova. CA 95670 <br /> LICENSE X C-57 C-61 D-09 L Other NUMBER 804318 EXPIRATION DATE 02/28{2022 <br /> BILLING PARTY: _OWNER I_:CONTRACTOR X SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING: -General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)C Arsenic(4393) <br /> INTENDED USE Domestic/Private - 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 ?New Well -Replacement Well r Well Alteration/Modification J Other <br /> Monitoring Well(s) #of wells Soil Boring(s) t1 of borings X Geotechnical_ 3 of borings <br /> Out-Of-Service Well C Out-Of-Service Well Renewal - Cross-Connection Repair <br /> New Pum [_Pump Replacement _Pump Repair E Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ,Mud Rotary C Air Rotary X Auger Cable Tool Push Point Other <br /> Proposed Well Depth 15-35 ft Excavation 6 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 Schad _Steel Plastic D Stainless Steel 'Other <br /> Grout Seal Depth 15-35 ft X Neat Cement(94 Ib bagl5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) .'Other <br /> Grout Placement Method Pumped X Free Fall 0 Other Retardant/Accelerator name <br /> Installed By Driller Pump Contractor I 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 C�,OOM�MPENSATION LAWS. <br /> Illil l8 O�{R A�t/ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED /� . .Arm_ TITLE OWNER DATE 8-26-2020 <br /> F YMEN <br /> C`c�VE� <br /> G 2� 202 <br /> r <br /> DEPARTMENT SE ONLY TL�`r <br /> Application Accepted B,, L L �r d ty Area q LI.( Employee ID#DA <br /> Grout Inspection By Date ❑ SPECIALWell Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Boring Inspection By �' n,'S _ Date W j t jA Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#I Amount Permit/ <br /> Codes Info 6 Cash Remitted tspi-vDate ice Request# Invoice# Well IN <br /> /c ' xu •Zl <br /> EHD 43-06 6111/2019 /13.2-3, 21- WELL/PUMP PERMIT <br />