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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 /> a+�(74 r. sHe +ar CITY21P Linden,CA/95236 M <br /> JOB ADDRESS bDD <br /> SCaIOn BeIIOta Rd and E Shelton <br /> CROSS STREET093-180-04 PARCEL SIZE 7.93 Be LAND USE APPLICATION# A <br /> OWNER NAME <br /> Stockton East Water District PHONE ( �209 948-0333 y <br /> OWNER ADDRESS 6767 East Main Street CITY/STATE/ZIP Stockton,CA 95215 <br /> CONTRACTOR Taber Drilling PHONE 916.371.1690 <br /> CONTRACTOR ADDRESS 536 Galveston St. CITY/STATE/ZIP W Sac,CA 95691 <br /> SUBCONTRACTORICONSULTANT HDR Inc. PHONE 279-321-6357 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 2365 Iron Point Road,Suite 300 CITY/STATE/ZIP Folsom,CA 95630 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 969927 EXPIRATION DATE 02.28.2022 <br /> BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring X Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings X Geotechnical 4f #of borings <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 <br /> Drilling Method XMud Rotary Air Rotary Auger Cable Tool Push Point Other MC. <br /> Proposed Well Depth 70 ft Excavation 4 in diameter Open Bottom Gravel Pack/Gravel Size in diam t C C/`�N r <br /> Conductor Casing in diameter / Conductor Casing Depth It ` �D <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 70 It X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mW7 gal wattAt' <br /> Bentonite(20%solids) Other S A.A 2020 <br /> Grout Placement Method Pumped Free Fall Other Retardant/Accelerator(name) q U//V <br /> PEDESTAL Installed By Driller Pump Contractor Other TN NM'Ejv Y <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe Pq RTM k <br /> PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level ft ENT <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 /> MI 48 HOUR NCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Executive Vice President DATE 10.15.2020 <br /> DEPARTMENT USE ONLY Jj <br /> Application Accepted By ��i GL Date d 1�Q (S Area Employee ID# DA <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date 0\ Z\ 2> Constructed Well Depth ft <br /> COMMENTS H `i•S l�CS os"- (-yC. ..�c�� b <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info ash Remitted Service a est# <br /> a37a S D 197,7 <br /> EHD 43-06 6/172019 �n //� I WELL/PUMP PERMIT <br />