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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADORE R60G "�O+' CITY/ZIP Stockton CA iq533�, m <br /> CROSS STREF ��N`' ` �� _PARCEL �q 1 7 _LAND USE APPLICATION# <br /> OWNER NAME City of Stockton p F)`/Q ^6gryl Q,Y3 69faUJ2 LLC.- PHON�fC ry <br /> OWNER ADDRESS 42-&N-.-Ef DOr2do-Street- 151 0 J'C(Ck 1 J AI C CITY/STATE/LP �`6lk <br /> 952&2 "I <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATEIZIP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CRy/STATErbp Clovis,California 93612 <br /> LICENSE /C-57 1-1 C-61 D-09 c Other NUMBER 499908 EXPIRATION DATE 10.21 2021 <br /> DOMESTIC WELL SAMPunI )General Mineral/Coliform Bacteria(4391)1 Dibromochloropropane(4392). Arsenic(4393) <br /> INTENDED USE C Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> li Public Water System <br /> If dfrerent from Owner. Water System Name Contact Name or Phone Number <br /> TYPE OF WORK ❑New Well Replacement Well I Well Alteration/Modification r I Other <br /> MonitoringWell(s) #of wells ]Soil Boring(s) #of borings /(Geotechnical 8 #ofbonngs <br /> I Out-Of-Service Well L Out-Of-Service Well Renewal I Cross-Connection Repair-T2d=56Feet) <br /> New Pump I I Pump Replacement L Pump Repair i,Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary I Air Rotary V Auger Cable Tool i i Push Point i Other <br /> Proposed Well DepthgjQ-15Z) ft Excavation in diameter I Open Bottom i Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth <br /> RD-5'0 ft V Neat Cement(94 Ib bag15-10 gal water) Sand Cement sack mixn gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method i Pumped i Free Fall I Other 1 1 Retardant/Accelerator(name) <br /> PEDESTAL Installed By i Driller i Pump Contractor -I Other <br /> Concrete Pedestal I!Dimensions:Width ft Length It Thick in Christy Box Stove Pipe <br /> PUMP Submersible .Turbine I I Other HP Pump Set It 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 WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HDy6NC.E,NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED T­z <br /> TITLE Managing Engineer DATE 11/18/2020 <br /> IL <br /> Ell <br /> T <br /> D <br /> 20 <br /> UNTY <br /> EM"� <br /> L <br /> ENT <br /> / DEPARTMENT USE <br /> Application Accepted By Dale Area /yc �� Employee ID# y <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By t Date WAIVER Received <br /> Soil Boring Inspectio�jB p I'1l�, C u ce'%J( i�..+L Date Constructed Well Depth ft <br /> COMMENTS (^IJ �YA &X IZ 'ot N!20 <br /> PE SC Received Check#/ Amount ate Penult/ Invoice# Well ID# <br /> Codes Info Py. Cash Remitted rvi e uest# <br /> 437a )Q Sad e S <br /> EHD 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />