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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,)a l N ZUCKERMAN RD AT GPS:37.995420,-11221.4788685(WELL#2)_ cITY1zIP STOCKTON,CA 95206 m <br /> CROSS STREET N ZUCKERMAN RD APN 13 q0 90 PARCEL SIZE 5( LAND USE APPLICATION# o <br /> A <br /> m <br /> OWNER NAME AECOM PHONE r!' <br /> OWNER ADDRESS 300 LAKESIDE DR CITYISTATEIZIP OAKLAND,CA 94612 <br /> CONTRACTOR CORRPRO COMPANIES INC PHONE <br /> CONTRACTOR ADDRESS 2625C BARRINGTON CT CITY/STATE/ZIP HAYWARD,CA 94545 <br /> SUBCONTRACTOR/CONSULTANT CC, PHONE <br /> SUBCONTRACTOR/CONSULTANT ADDRESS CITY//STATE/ZIP_ <br /> LICENSE ♦C-57 C-61 D-09 Other NUMBER 71�I Y78' ExPIRATION DATE � 30'702 <br /> BILLING PARTY: OWNER N/ONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring 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 Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings Geotechnical #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method VMud Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth 227 it Excavation 10 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thicknes Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal D Pth 100 ft V Neat Cement(94/b bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> N <br /> V Bentonite(20%solids) Other BeAo-de 100-54 a Neat cemed 53-3 t <br /> Grout Placement Method Pumped Free Fall Other Retardant/Accelerator'name <br /> IPFUESIAL Installed By Driller Pump Contractor 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 COMPENSATION LAWS. <br /> MINIMUM 448 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ` '�' TITLE OPERATIONS MANAGER DATE 8 06 2020 <br /> EANT <br /> FD <br /> 42 <br /> 0 / R oUN q L rY <br /> a MENT <br /> EPARTMENT USE ONLY <br /> C <br /> Application Accepted By Date Area 3 -/ Employee ID# <br /> Grout Inspection By Date I SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#1 Amount ate Permit/ Invoice# Well ID# <br /> Codes Info ash Remitted Seryice a uest# <br /> EHD 43-06 6/11/2019 _ WELL/PUMP PERMIT <br /> Chi , ll 2_3S022 � <br />