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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 3434 S.Manthey Road cITYZP Stockton,95206 m <br /> D <br /> CROSSSTREET Carolyn Weston Blvd APN 16422006 PARCEL SIZE 5.99 LAND USE APPLICATION# z <br /> m <br /> OWNER NAME Jenkins Enterprises LLC PHONE 909-800-8465 <br /> OWNER ADDRESS 75 E Daily Drive#225 CITY/STATE//JP Camarillo,CA 93011 <br /> 00 <br /> Oo <br /> CONTRACTOR Salem Engineering Group,Inc. PHONE 559-271-9700 <br /> Z <br /> CONTRACTOR ADDRESS 4729 West Jacquelyn Avenue CITY/STATEZP Fresno,California 93722 <br /> SUBCONTRACTOR/CONSULTANT Salem Engineering Group.Inc. PHONE 559-271-9700 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 4729 West Jacquelyn Avenue CITY/STATE/zip Fresno,California 93722 <br /> w <br /> LICENSE V C-57 C-61 D-09 Other NUMBER 970772 EXPIRATION DATE 3/31/2022 fD <br /> BILLING PARTY: i i OWNER I CONTRACTOR If SUBCONTRACTOR/CONSULTANT y <br /> DOMESTIC WELL SAMPLING:i i General Mineral/Coliform Bacteria(4391) i Dibromochloropropane(4392)i i Arsenic(4393) n <br /> INTENDED USE i Domestic/Private i Irrigation/Agricultural i Industrial i Water Quality Monitoring a Soil Sampling/Characterization <br /> I Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK 1 New Well i Replacement Well Well Alteration/Modification i Other <br /> Monitoring Well(s) #of wells Soil Borings) #or borings V Geotechnical four #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> I New Pump Pump Replacement Pump Repair i Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary /Auger Cable Tool Push Point Other <br /> Proposed Well Depthlift Excavation 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 r Other <br /> Grout Seal Depth 15 to 25 ft -/Neat Cement(94/b bag15-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method I Pumped ✓Free Fall J Other Tremmie Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor I Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in i Christy Box i i Stove Pipe <br /> PUMP i Submersible Turbine 1 Other HP Pump Set It 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 COM ENSATION LAWS. <br /> II UI111 �HOUR ADV ICEXeTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> 7 <br /> SIGNED TITLE Geotechnical Staff Engineer DATE 9/2/2020 <br /> EENT <br /> I VFD <br /> S <br /> ARTM� TY <br /> ENT <br /> l DEPARTMENT USE ONLY fit_ <br /> Application Accepted By �— f�`/� Date 9 0AreaJ� l+� mployee ID# u ` <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date L << Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Chec Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B ash Remitted Service Re uest# <br /> 4374 soy/i� 1 <br /> EHD 43-06 6/112019 WELL/PUMP PERMIT <br />