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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 209 853-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> m <br /> Joe ADDRESS 1819 S Argonaut Street CITy/bp Stockton,CA 95206 n <br /> CROSSSTREET Charter Way APN 16320008 PARCELSIZE LAND USE APPLICATION# °a <br /> A <br /> OWNER NAME John Taylor Fertilizer c/o Eric Jenks PHONE 510-236-6282 u <br /> OWNER ADDRESS PO Box 511 cITY/STATE0p Yuba City,CA 95991 <br /> CONTRACTOR Gregg Drilling&Testing PHONE 925-313-5800 <br /> CONTRACTOR ADDRESS 950 Howe Road Cr1y/STATE/LP Martinez,CA 94553 <br /> SUBCONTRACTOR Geosyntec Consultants PHONE 916-637-8329 <br /> SUBCONTRACTOR ADDRESS 3043 Gold Canal Drive#300 Cr1y/STATE/7jP Rancho Cordova,CA 95670 <br /> LICENSE X C-57 C-61 609 Other NUMBER 485165 EXPIRATION DATE 1/31/2018 <br /> GEOGRAPHICAL INFORMATION: Coordinates X N37,55'59" y W121.18'18" Township_ Range_ Section_ <br /> INTENDED USE DomesticfPrivate Irrigation/Agricultural �Industrial X Water Quality Monitoring Soil Samping/Characterization <br /> Public Water System Peter Dennehy-916-637-8341 <br /> l(filfwent from Owner Water ys em Nam GM.0 N.—or P11mi.N.mbit, <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> X Monitoring Walls) 14 #of wells _ Soil Boring(s) •of Iwrmps _Geotechnical D of°°`tags <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 Rotosonic(13)and horizontal mud rotary(1) <br /> Drilling Method X Mud Rotary Air Rotary i Auger Cable Tool Push Point X Other <br /> Proposed Well Depth 1,r30e am lD.eOn am f.hon onmiwea.o rift Excavation in diameter 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 (12)X Plastic(2)XStainless Steel I Other <br /> Grout Seal Depth 10 to 6oft,4 to 15 ft X Neat Cement(94 Ib bays-10 gal water I Sand Cement sack nrx/7 gal water <br /> Bentonile(20%solids) i Other <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By X Driller I Pump Contractor X Other Flush mounted road box or well vault <br /> Concrete Pedestal.Dimenskms:Width It Length It Thick in ..Christy Box Stove Pipe <br /> PUMP Submersible Turbine i Other HP Pump Set It Standing Water Level h <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPUCATION 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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED Peter Dennehy,P.G. TITLE Hydrogeologist-Geosyntec Consultants DATE <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID#, <br /> Grout Inspection By Dale SPECIAL Well Permit <br /> Pump Inspection By Date - WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date PermiU Invoice# WeIIID# <br /> Codes Info B Cash Remitted Service uest# <br /> END a3.06 WELL(PUMP PER MIT <br /> aawr2 <br />