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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 Port of Stockton Port Rd F CITY/ZIP Stockton T <br /> D <br /> CROSS STREET Port Rd. 15 APN 14503001 PARCEL SIZE 9593 LAND USE APPLICATION# z <br /> Acres m <br /> OWNER NAME ALAMCO PHONE <br /> OWNER ADDRESS 1776 W.March Lane,Suite 420 CITYISTATE/ZIP Stockton,CA 95207 <br /> CONTRACTOR Kelinfelder PHONE 209-981-7755 <br /> CONTRACTOR ADDRESS 2001 Arch Airport POrt,Suite 100 CITY/STATE/ZIP <br /> SUBCONTRACTOR/CONSULTANT V and W Drilling PHONE 209-981-7755 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 1133 Blackhurst Dr CITY/STATE/ZIP Gall,CA,65632 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 720904 EXPIRATION DATE 04/30/2020 <br /> BILLING PARTY: OWNER X CONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE I Domestic/Private i Irrigation/Agricultural I I Industrial I. Water Quality Monitoring 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 New Well Replacement Well I Well Alteration/Modification I Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings x Geotechnical 3 #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 X Mud Rotary Air Rotary X Auger I Cable Tool Push Point Other <br /> Proposed Well Depth 30&80 ft Excavation in diameter I Open Bottom Gravel Pack/Gravel Size in diameter <br /> 1 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad I Steel Plastic I Stainless Steel I Other <br /> Grout Seal Depth 30&80 ft x Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mixl7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> I Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP I Submersible) Turbine I I 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED (/ ^ TITLE Project Professional DATE 4/10/2020 <br /> I <br /> QC NjFNT <br /> Fl QED <br /> oxi <br /> N 3 2020 <br /> rbN 11 U 11 Lill It /V <br /> F ARTA L <br /> MINT <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Cesar Ruvalcaba Date 4/13/2020 Area 1/Stockton Employee ID# DA <br /> Grout Inspection By Date SPECIAL Weil Permit <br /> Pump Inspection By nn Date WAIVER Received <br /> Soil Boring Inspection By 6r4f.t r S I i! Date *Z(41 r 1 Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info J3191 Cash Remitted Service Re uest# <br /> 4372 150 j $760 ,2t/ WP0040720 <br /> EHD 43-0fi 8/112019 �07�7��q WELL/PUMP PERMIT <br />