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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.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> 0 <br /> JOB ADDRESS 3146 Odell Ave CITY/ZIP Stockton/95206 m <br /> D <br /> CROSS STREET W Ivy Ave APN 175-110-28 PARCEL SIZE 2.17 Acres LAND USE APPLICATION# o <br /> OWNER NAME Bennie Taylor PHONE N <br /> OWNER ADDRESS 3360 De La Cruz Blvd CITY/STATE/ZIp Santa Clara/CA/95054 <br /> CONTRACTOR West Coast Exploration,Inc PHONE (209)985-7541 <br /> CONTRACTOR ADDRESS P.O.Box 133 CIN/STATE/ZIP Escalon/CA/95320 <br /> SUBCONTRACTOR/CONSULTANT CTE CAL,INC. PHONE (209)543-1799 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 4230 Kieman Ave,Suite 150 CITY/STATE/ZIP MODESTO/CA/95356 <br /> LICENSE X C-57 C-61 D-09 _i Other NUMBER 870761 EXPIRATION DATE 1/31/2022 <br /> BILLING PARTY: OWNER '..CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural C 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 _I Replacement Well Well Alteration/Modification E Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings x Geotechnical 6 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump i Pump Replacement 1 Pump Repair 0 Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary X Auger L Cable Tool i Push Point 0 Other <br /> Proposed Well Depth 10 It Excavation 4 inches in diameter 1 Open Bottom I I Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM Schad 0 Steel 7 Plastic D Stainless Steel 0 Other <br /> Grout Seal Depth 10 ft X Neat Cement(941b bag/5-10 gal water) -i Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) �j Other <br /> Grout Placement Method Pumped Free Fall X Other Tremie It in Retardant/Accelerator(name) <br /> 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 f: <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 /nfit"�/L(,t.!JG�Lifi TITLE Staff Geologist DATE 8/24/2020 <br /> S E E A T T A C H E D <br /> RFq y� <br /> tir <br /> A. <br /> Q/V <br /> F R� <br /> TMAltir <br /> DEPARTMENT USE ONLY ,/ d a. <br /> Application Accepted By �/�N Date J �� Area I(/ Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By A DateWAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Cas Remitted Service Re uJT <br /> est# <br /> Jib d1E <br /> EHD 43-O6 6/1112019 � / / �����/ WELL(PUMP PERMIT <br />