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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-REFUNDA LE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS-2B5 Inglewood Ave.Stockton.CA 95207(GPS:38.014877.-121.317387E CITYIZIP` Stockton,CA 95207 m <br /> CROSS STREET W LINCOLN RD APN J 01,3 ,e ,r PARCEL SIZE °IS <br /> _ng� t � LAND USE APPLICATION# A <br /> OWNER NAME City of Stockton PHONE m <br /> OWNER ADDRESS City Hall,425 N,EI Dorado St CRY/STATE/ZIP Stockton,CA 95202 <br /> CONTRACTOR Underground construction Co. PHONE 707-741-1761 <br /> CONTRACTOR ADDRESS 5145 Industrial Way CITY/STATE/ZJP Benicia,CA 94510 <br /> SUBCONTRACTORICONSULTANT Conpro Companies Inc.., PHONE 510-509-4993 <br /> SUBCONTRAC`TOORICONSULTANT ADDRESS 2625c Barrington Court CITY/STATE/ZIP Hayward Ca 94545 <br /> LICENSE ♦C-57 C-61 D-09 Other NUMBER 764878 EXPIRATION DATE 06/30/2021 <br /> BILLING PARTY: OWNER CONTRACTOR /SUBCONTRACTOR/CONSULTANT <br /> DOMEsnc WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Courant Naym,or,�Phenn N.,mhor i <br /> TYPE OF WORK )(New Well Replacement Well Well Alteration/Modification Other _ �t�`'r 1 ode (/�f'}5 ''v FP.� <br /> �F , <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings Geotechnical 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 VM.d Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth 49_ft Excavation &I in diameter Open Bottom lllifGravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickne Gauge/ASTM Schad Steel Plastic Stainless Steel Other No Casing <br /> Grout Seal _C pth_8 _ _ft V Neat Cement(94 Ib bagl5-10 gal water) Sand Cement sack mix/7 gal water <br /> �/ 11-3'NEAT CEMENT <br /> Bentonite(20%solids) Other ' <br /> Grout Placement Method Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL 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 It <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 ADVA_N�CE�NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �Y TITLE Construction Manager DATE 01/22/2021 <br /> flAENT <br /> IVED <br /> 8 2021 <br /> UIN COUNTY <br /> NMENTAL <br /> EPARTMENT <br /> DEPARTMENT USE ONLY I <br /> Application Accepted By Date 0-W/ Area.,? =f ' Employee ID# DA <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS (Iec.,r 7,2DIn 4k rim <br /> t <br /> SC Received Amount Date Permit/ Invoice# Well ID# <br /> Info ash Remitted SeMceRe nest# <br /> s 3aod <br /> EHD43-06 6/11/2019 WELL/PUMP PERMIT <br />