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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 I YEAR FROM DATE ISSUED <br /> STOCKTON,CA 95206 <br /> JOB ADDRESS 2il�IN ZUCKERMAN RD AT GPS:37.996185,-121.478697(WELL#3) CrrylbP - In <br /> 0 <br /> CROSSSTREET NZUCKERMANR'D APN PARCEL SIZE_k'T2.4��LAND USE APPLICATION# 0 <br /> OWNER NAME AECOM PHONE <br /> OWNER ADDRESS 300 LAKESIDE DR CrrY/STATE/ZIP A <br /> CONTRACTOR CORRPRO COMPANIES INC.. PHONE <br /> CONTRACTOR ADDRESS 2625C BARRINGTON CT CITYISTATEIZIP HAYWARD,CA 94-545 <br /> SUBCONTRACTORICONSULTANT cc., PHONE <br /> SU13CONTRACTORICONSULTANT ADDRESS CITYISTATEIZP— <br /> LICENSE V/C-57 C-61 D-09 Other NUMBER 7AI97F ExPiRATION DATE_ 1?0; <br /> PILLING PARTY: OWNER IVONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391)-j Dibromochloropropane(4392)-2 Arsenic(4393) <br /> INTENDED USE u,Domestic/Private Irrigation/Agricultural i Industrial i Water Quality Monitoring -Soil Sampling/Characterization <br /> L:Public Water System <br /> If different from Omer. Water System Name Contact Name or Phone Number <br /> TYPE OF WORK 7,New Well Replacement Well L Well AlterationlModification Vother <br /> F,Monitoring Well(s)_#of wells -Soil Boring(s) #of borings Geotechnical #of bo-q-, <br /> ,7,Out-Of-Service Well L Out-Of-Service Well Renewal Cross-Connection Repair <br /> - New Pump L Pump Replacement -1 Pump Repair L Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method V/M.d Rotary Air Rotary --Auger i Cable Tool Push Point -, Ot�7 <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 It <br /> Well Casing Diameter—in ThicknesyGauge/ASTM Schad — "Steel Plastic , Stainless Steel ,Other <br /> Grout Seal D th 100 ft V Neat Cement(9,4 lb bagIS-10 gal water) Sand Cement sack mix17 gal water <br /> p' <br /> ,7B.ntonite(20%solids) F- Other Behliolri-te 100-54 a Aat oeme-t 53-3 t <br /> lGrout Placement Method Pumped Free Fall -Other —c Retardant/Accelerator(name) <br /> Installed By i Driller �Pump Contractor I Other <br /> Concrete Pedestal� Dimensions:Width—ft Length—It Thick—in - Christy Box i Stove Pipe <br /> 1PUMP 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 NTH 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 /> SirNED TITLE OPERATIONS MANAGER DATE 8 06 2020 <br /> el <br /> J <br /> L <br /> 2020 <br /> Nfl�fr7ROtv COLJ <br /> 771 - NTY <br /> 4t 4IEtv <br /> D E PARTMENT L�SE ONLY <br /> Application Accepted By 4w-4,z�- Date L2PZ0, Area -C/.qcf Employee IN DA <br /> Grout Inspection By Date E SPECIAL Well Permit <br /> Pump Inspection By Date 0 WAIVER Received <br /> Soil Boring Inspection By Datte Con t t d Well Depth qY� ft <br /> TRe <br /> COMMENTS 04 14, <br /> V <br /> dwa*"t4j&- t&�P4 11" ofn, <br /> 'r. , <br /> PE SC Received Check#/ Amount Permit/ Invol ID# <br /> Codes Info /,Cash Remitted Date §nice Eeq uest# ce# Well <br /> EHD43-06 611112019 12-z2 S� WELL/PUMP PERMJT <br />