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JOB ADDRESS 6701 Jack Tone Road Tyjzip Stockton, 95215 <br /> <br />CROSS STREET Mariposa Road APN 181-080-180-000 <br />OWNER NAME <br /> ESCALON UNIFIED, SCHOOL DISTRICT <br />OWNER ADDRESS 1520 Yosemite Avenue <br />CONTRACTOR <br /> V & W DRILLING INC <br />CONTRACTOR ADDRESS 1133 BLACKHURST DR <br />PARCEL SIZE 707 Acre' LAND USE APPLICATION # <br />PHONE 209-838-3165 <br />Cry/STATE/ZIP Escalon, CA, 95320 <br />PHONE (209) 469-7700 <br />CITY/STATE/Zip GALT, CA 95632 <br />SUBCONTRACTOR/CONSULTANT Wallace-Kuhl & Associates PHONE 916-997-1546 <br />SUBCONTRACTOR/CONSULTANT ADDRESS 3050 Industrial Blvd CITY/STATE/Zip West Sacramento, CA 95691 <br />LICENSE VC-57 I C-61 I D-09 I Other NUMBER 720604 <br /> <br />EXPIRATION DATE 4/30/2022 <br />BILLING PARTY: <br /> <br />OWNER <br /> XCONTRACTOR VSUBCONTRACTOR/CONSULTANT <br />ft Standing Water Level Pump Set ft : Submersible I Turbine Other HP PUMP <br />ft Thick <br />PEDESTAL <br />in II Christy Box 1 , Stove Pipe <br />Installed By ! Driller I Pump Contractor 1. Other <br />I Concrete Pedestal I Dimensions: Width ft Length <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary I Air Rotary VAuger I Cable Tool I Push Point Other <br />Proposed Well Depth 10 to 21.5 ft Excavation 6 to 8 in diameter I Open Bottom I Gravel Pack/Gravel Size in diameter <br />I Conductor Casing in diameter / Conductor Casing Depth <br />Diameter in fhickness/Gauge/ASTM Sched 1 Steel <br />Depth 13 t,D ft '('Neat Cement (94 lb bag/5-10 gal water) <br />I Bentonite (20% solids) I Other <br />Grout Placement Method I Pumped VEree Fall 11 Other I Retardant / Accelerator (name) <br />Well Casing <br />Grout Seal <br />ft <br />Plastic Stainless Steel I Other <br />1, Sand Cement sack mixil gal water <br />Ce— <br />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 />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391)1 . Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE Domestic/Private 11 Irrigation/Agricultural Industrial I Water Quality Monitoring "(Soil Sampling/Characterization <br />Public Water System <br /> <br />It different horn Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK I New Well 1 Replacement Well Well Alteration/Modification 1 Other <br />I Monitoring Well(s) # of wells . Soil Boring(s) Cot borings VGeotechnical 4 #01 borings <br />1 Out-Of-Service Well , Out-Of-Service Well Renewal 1 Cross-Connection Repair <br />, New Pump I 1 Pump Replacement I Pump Repair 11 Raise Well Casing <br /> <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. :SS32100V 3115 SIGNED <br />e, <br />SAN <br />Jilly 2 <br />MI MUM 48 HOU .' • : • - NCENOTICE REQUIRED FOR lh SP CTION - PLEASE CALL (209) 953-7697 <br /> Mr! AI ,I TITLE DATE 4,191 (.-. I"'" LC' /) <br />-7 <br /> PAymorr <br />Ree &vett <br />o 2021 <br />..fiztiou <br />114,ftiON N couN <br />n/DeptivrAt rY NEAir <br />DEPARTMENT USE ONLY <br /> <br />Application Accepted By ---- Date Va°//1 / Area q Employee ID# <br /> <br />Grout Inspection By Date 1 1 SPECIAL Well Permit <br /> <br />Pump Inspection By Date I WAIVER Received <br />Soil Boring Inspection By Q‘ilptvs\f'• ,:glcSAC '','4,',_,-, Date '2.- 1 \ l -L. \ Constructed Well Depth ft <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By <br />(lied, Amount <br />Remitted Date <br />^ 't .7 i <br />Permit/ Invoice # Well ID# <br />14 3-4,2 / S 0 aUtc 5 a orjr1 4,(4 /„2 i ku „I <br />Seryice Request #24 <br />waoti I lp <br />EHO 43-06 6/11/2019 WELL /PUMP PERMIT