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OWNER ADDRESS 1875 W I °well Avenue <br />CONTRACTOR Baja Exploration <br />CONTRACTOR ADDRESS 1915 Commercial Street crryisTATErbp Escondido, CA 92029 <br />PHONE 760-743-7678 <br />PHONE 916-853-9293 <br />cireisTATEtzip Rancho Cordova, CA 95670 <br />NUMBER 804318 ExPiRATioN DATE 02/28/2022 <br />SUBCONTRACTOR/CONSULTANT BSK Associates <br />SUBCONTRACTOR/CONSULTANT ADDRESS 3140 Gold Camp Dr. #160 <br />LICENSE x C-57 C-61 D-09 Other <br />crryisrArerup Tracy, CA 95376 <br />BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br />Water Quality Monitoring X Soil Sampling/Characterization INTENDED USE Domestic/Private Irrigation/Agricultural Industrial <br />If different from Owner <br />Public Water System <br />Water System Name <br />2 #01 borings Soil Boring(s) #01 borings X Geotechnical <br />Out-Of-Service Well Renewal Cross-Connection Repair <br />Pump Repair Raise Well Casing <br />sack mixt7 gal water <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br />Proposed Well Depth 15 ftExcavation 6-8 in diameter Open Bottom 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 15 ft x Neat Cement (94/b bag/5-10 gal water) Sand Cement <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped x Free Fall Other Retardant / Accelerator (name) <br />Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length ft Thick in Christy Box Stove Pipe <br />PEDESTAL <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />New Well Replacement Well <br />Monitoring Well(s) # of wells <br />Out-Of-Service Well <br />New Pump Pump Replacement <br />Well Alteration/Modification Other TYPE OF WORK <br />PUMP HP ft Pump Set ft Standing Water Level Submersible Turbine Other <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 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED /04-3/1 TrrLE Owner DATE 3/5/2021 <br />Contact Name or Phone Number <br />s,4 <br />/-/4- Az. <br />_5ee_ <br />Area SP-147 Employee ID# As• <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />WELL/PUMP PERMIT <br />1868 EAST HAZELTON AVENUE- STOCKTON CA 95205-6232 (209) 468-3420 <br />ov.or. /ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />CITY/ZIP Tracy, CA 95376 <br />PARCEL SLZE 30 /KANO USE APPLICATION # <br />PHONE 209-830-3200 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />NON-REFUNDABLE PERMIT wWW.S <br />JOB ADDRESS 315 E 11th Street <br />CROSS STREET Fast Street APN 23337010 <br />OWNER NAME <br /> Tracy Unified School District <br />DEPARTMENT USE ONLY <br /> <br />Application Accepted By Date viipi <br /> <br />Grout Inspection By fradi c: S Cilcuit: I., PL.:2, Date 31 gi 742.1 <br /> <br />Pump Inspection By Date <br /> <br />Soil Boring Inspection By Date <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info <br />Received Check/f/ <br />_ Cask. <br />Amount <br />Remitted Da Permit/ Invoice /f Well ID8 <br />1417 a )51) 131 (. (..fe-e.-f . Co' 'bitilezi <br />,Sirvic_e liewesittei <br />WV001f191 <br />." <br />END 43-06 6/11/2019 <br /> <br />/2/ 73/37 <br /> <br />WELL /PUMP PERMIT