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f , <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.sjqov.o!q/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 2651 South Airport Way CITYZp Stockton.CA 95206 N <br /> A <br /> CROSS STREET E 12th Street APN 169-120-030-000cD <br /> PARCEL SIZE 7.810 aaee LAND USE APPLICATION# S <br /> m <br /> OWNER NAME - li PHONE (209)271-3129 to <br /> OWNER ADDRESS 1718 BOeino Way CITYISTATEZP Stockton,CA 95206 <br /> CONTRACTOR RMA GeoScience,Inc. PHONE (559)708-8865 <br /> CONTRACTOR ADDRESS 3897 N.Ann Ave. CITY/STATEZP Fresno.CA 93727 <br /> SUBCONTRACTORICONSULTANT Salem Engineering Group PHONE (559)271-9700 <br /> SUBCONTRACTOR)CONSULTANT ADDRESS 4729W.Jacquelyn Ave. CRY/STATE/LP Fresno,CA 93722 <br /> LICENSE X C-57 C-61 D-09 Othe! NUMBER 970772 EXPIRATION DATE <br /> BILLING PARTY: OWNER XCONTRACTOR 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 Sampiing/Charactenzabon <br /> Public Water System <br /> If 6flam t from Owner Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification X Other Geotechnical Investigation <br /> Monitoring Well(s) #of wells Sal Bonng(s) Mol bonngs X Geotechnical 31 _#of bonngs A <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well CasingREQ M�N <br /> WELL CONSTRUCTION No wells will be installed.Just three(3)geotechnical borings to 25'. <br /> Drilling Method Mu^Rotary Air Rotary X Auger Cable Tool Push Point Other C <br /> Proposed Well Depth #15' it Excavation 7 in diameter Open Bottom Gravel Pack/GravelOC` <br /> Gravel Size in diameter `T /Z <br /> Conductor Casing in diameter / Conductor Casing Depth 11 Sq JO �0?® <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other V/ /N <br /> Grout Seal Depth_ �It X Neat Cement(94/b bag/5-10 gal water) Sand Cement sack mtx8 g tg} r�ONM6CO(JNT <br /> Bentonite(20%solids) Other DEP4 rrQ L Y <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator(name) 61V7, <br /> PEDESTAL NIA Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions.Width ft Length It Thick in Christy Box Stove Pipe <br /> PUMP NIA Submersible Turbine 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 A TIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT i AM IN COMPLIANCE WITH ALL <br /> WORKERSC ATIO LAWS. <br /> t1��;;;IWAD NC N CE REQUIRED FOR INSPES-PLEASE CALL(209)953-7E97 <br /> /10 <br /> SIGNS TITLE 'l DATE <br /> At 1.1-1w— <br /> FT- <br /> 1 DEPARTMENT U$EONLY J� <br /> Application Accepted By ���`�� Date jobo <br /> —VV Area txk}on Employee ID#DA <br /> Grout Inspection By Dale SPECIAL WBII Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By -Ti :j La (tVi• ry4,y Date Lv Constructed Well Depth n <br /> COMMENTS <br /> PE Sc Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Cash Remitted Service Re u ist# <br /> d 8 f 760 <br /> EHD 4]-06 8/11/1019 e � 1 I������ WELL(PUMP PERMR <br />