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RegSpfiggit, II New Well ii Replacement Well If Weil AileratIon/Modification H Other <br />Monitoring Was) it of wells X SOO Bon/ta(e) olboTtnim XGeolechnical 1 <br />Out-Of-Service Well n Out-OSService Well Renewal : Cross-Connection Repair <br />New Pump • ' Pump Replacement Pump Repair ' Raise Well Casing <br />WELL CotreTenCnott <br />Drilling Method I Mud Rotary PJr Rotary XAcger Cable Tool c) Push Point Other <br />Proposed Well Depth 48 n Excavation 8 in diameter : Open Bottom Li Gravel Pack/Gravel Size in diameter <br />I Conductor Casing In diameter I Conductor Casing Depth <br />Well Casing Diameter In Thickness/Gauge/ASTM Schad Steel I I Plastic I Stainless Steel II Other <br />Grout Seal Depth ft ;INeat Cement Me lb baly5-10 gal vrator) Sand Cement sack n*17 gal water <br />Bentonite (20% soN-1 Other <br />Grout Placement Method U Pumped Free Fail Other Relardanl / Accekrator (name) <br />Instated By U Dreier U Pump Contractor [: Other <br />I I Concrete Pedestal , :Dimensions: Width ft Thick In Christy Box 11 Stove Pipe <br />Emmen. 11 Length <br />of Dodos* <br />rl Submersible' Turbine Other HP <br /> <br />Pump Set 11 Standing Water Level ft <br />CITY1STAIEJEUT <br />A PN 177-280-120 PARCEL SIZE 7.4 ac Lam USE APPLICATtON A <br />PHONE <br />Stockton, CA 95206 <br />p„,,„E (408) 280-6822 CONTRACTOR Exploration Geoservices, Inc. <br />PRONE (408) 245-4600 SUBCONTRACTORICONSULTANT Cornerstone Earth Group <br />BILLING PARTY: Omen CONDUCTOR X SUBCONTRACTORICONSULTANT <br />Joe AOORESS 1021 Industrial Drive crryrup Stockton. CA 95206 <br />CR0311 STREET S Airport Way <br />OWNER NAME ingredion. Inc. <br />OWNER ADORERS 888 Zephyr Street <br />CONTRACTOR ADDRESS 1535 Industrial Avenue cm/suet/up San Jose, CA 95112 <br />SUBCONTRACTORICONBULTANT ADDRESS 1259 Oakmead Parkway CITWSTATIRIP Sunnyvale. CA 95050 <br />MENU X C-57 :1 C-61 : DOS fi Other NUMBER 484288 EXPIRATION DATE <br />DOmESTIC WELL SAMPUNG: : General Mineral/C.oliform Bacteria (4391) n Dibromochloropropane (4392) . Arsenic (4393) <br />Canted Nome at flume mumeor <br />WEARER ung Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring : Soil SamplingiCharacterizabon <br />Public Water System <br />Water ITyslam Nano Udittervvt crom o,mar. <br />WELL/PUMP PERMIT <br />SAM JOAQUIN Cowry ENVIRONMENTAL HEALTH DEPARTMENT utan EAST NAZELTON AVENUE - STOCRION CA 95205 4232 (209)458-3420 <br />NON-REFUNDABLE PERMIT www.sjgov.orgiehd EXPIRES 1 YEAR FROM DATE ISSUED <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCAT1ON AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY OR NCE STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED 1JCENSE IS <br />CURRENT AND AC WI H CALIFORNIA CONTRACTORS STATE UCENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS CMPEN <br />MINI <br />SIGNED <br />DEPARTMENT USE ONLY <br />Application Accepted By .V...--,Z../__ Date V EmployeelOd Area.7..i/a <br /> <br />Grout Inspection By Date 7. SPECIAL Well Permit <br /> <br />Pump Inspection By Date - - WAIVER Received <br /> <br />Sod Boring Inspection By, °ale / Constructed Well Ditpth <br />COMMENTS • .,14YliC - et:7(7,f bo r ep " r / 3i,' '1 Sv} fee,7 r i et ' 1) <br />PE <br />Cones <br />SC <br />Info <br />Received Check* <br />et's/ h <br />Amount <br />Remitted <br />PermItt <br />ystptS 9 Invoke 0 Well ID. 23L. .r,1 Rqr•Date j sto <br />VANCE NOTICE REQUIRED FIINSPECTIONS - PLEASE CALL (209) 3-7 7 <br />.kt:StOtINet DATE 1— Arin <br />r5$ <br />ft <br />/2123 ()I,D WELL RUMP PERMIT END 4305 0112019