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1089 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 7007 St. Stark Rd. CITY/ZIP Stockton 95206 <br /> D <br /> CROSS STREET Muller APN 13-128-003 PARCEL SIZE 126.76 LAND USE APPLICATION# o <br /> A <br /> m <br /> OWNER NAME Del Carlo Farms PHONE 209-922-1450 <br /> OWNER ADDRESS 6717 Stark Rd. CITYISTATE/ZIP Stockton CA,95206 <br /> CONTRACTOR Delta Pump, Inc. PHONE 209-466-9625'5 <br /> CONTRACTOR ADDRESS 646 S California St CITY/STATE21P Stockton CA,95203 <br /> SUBCONTRACTOR/CONSULTANT PHONE <br /> SUBCONTRACTOR/CONSULTANT ADDRESS CITYISTATE21P <br /> LICENSE I C-57 X C-61 D-OBJ Other NUMBER 1055434 EXPIRATION DATE 7/3102021 —� <br /> BILLING PARTY: OWNER CONTRACTOR I i SUBCONTRACTORICONSULTANT <br /> DoMEsTTc WELL SAMPLING: -1 General Mineral/Coliform Bacteria(4391) -1 Dibromochloropropane(4392) -1 Arsenic(4393) <br /> INTENDED USE XDomestic;Private -1 Irrigation!Agricultural - Industrial Water Ouality Monitoring f Soil Sampling/Characterization <br /> i Public Water System <br /> If different frcrr Owrer. Water System Nam Contact Name or Phone Number <br /> TYPE OF WORK U New Well I Replacement Well Well Alteration,+Modification Other <br /> n Monitoring Well(s) #of'.wells - Soil Boring(s) #It h"IF J1 F Geotechnical III of bonn`1` <br /> I Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump I_ Pump Replacement X Pump Repair Raise Well Cash <br /> WELL CONSTRUCTION <br /> Drilling Method � Mud Rotary L Air Rotary U Auger U Cable Tool Push Point Other <br /> Proposed Well Depth fl Excavation in diameter I 1 Open Bottom Gravel Pack:Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thick ness'Gauge.ASTM Sched I Steel Plastic I Stainless Steel Other <br /> Grout Seal Depth ft _ Neat Cement(94 1b bag/ 10 gal waterl Sand Cement sack rmz.4 gal Muter <br /> I Bentonite(20%solids) Other <br /> Grout Placement Method _. Pumped -1 Free Fall Other L Retardant!Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor - Other <br /> l Concrete Pedestal-Dimensions Width ft I-ength ft Thick in Christy Box i I Stove Pipe <br /> PUMP X Submersible_ Turbine Other HP Pump Set it Standing Water Level tt <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 /> MI* r' �'„� 1u t� UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL(209)953-7697 <br /> SIGNED TrME CEO DATE 11/11/2020 <br /> t K <br /> t <br /> Pump set <br /> back in trees 'Willi <br /> uF `r <br /> 1' oP <br /> j DEPARTMENT USE ONLY i <br /> Application Accepted By L1"L, Date 23loa ;o.ZO Area —�/ �` Employee IUN ' <br /> Grout Inspection By Date I SPECIAL Well Permit <br /> r {, /l <br /> Pump Inspection By I=t i�ti 1�al Ak`� Date 1Z'�l�20'7_0 WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PAYMENT <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# E�1f�� <br /> Codes Info B Cash Remitted Service Re uest# <br /> �i3� X50 2% 3 47 i P - f <br /> am"iIN <br /> I <br /> EHD 43-06 61112019 <br />