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JOB ADDRESS 1021 Industrial Drive cirdzip Stockton. CA 95206 <br />CROSS STREET S Airport Way APN 177-280-140 PARCEL SIZE 35.9 ac LAND USE APPLICATION # <br />OWNER NAME Ingredion, Inc. Ryan, LLC PHONE <br />OWNER ADDRESS One PPG Place. Suite 281 2810 CITY/STATERIP Pittsburgh, PA 15222 <br />CONTRACTOR Middle Earth Geotesting, Inc PHONE (714) 633-5025 <br />CONTRACTOR ADDRESS 27639 Industrial Boulevard crryisTATEizip Hayward, CA 94545 <br />SUBCONTRACTOR/CONSULTANT Cornerstone Earth Group PHONE (408) 245-4600 <br />SUBCONTRACTOR/CONSULTANT ADDRESS 1259 Oakmead Parkway CITY/STATE/ZIP Sunnyvale, CA 95050 <br />LICENSE X C-57 C-61 0-09 Other NUMBER 899451 EXPIRATION DATE <br />BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />II 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) hot wells XSoil Boring(s) # of borings XGeolechnical 6 #ol bor ngs <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 />Method Mud Rotary Air Rotary Auger Cable Tool Push Point X Other Cone Penetration Testing <br />Drilling <br />Proposed Well Depth 150 ft Excavation 2.5 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Casing Diameter in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other Well <br />Grout Seal Depth s D ft Neal Cement (94/b bag/5-10 gal water) Sand Cement sack mix17 gal water i ,'" <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped : Free Fall )! Other _thf.4.) 'rVd_r Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length ft Thick in Christy Box Stove Pipe <br />PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT <br />JOAQUIN OUN • RDINANCES, STATE LAWS, AND RULES AND REGULATIONS. <br />CURRENT •\_. A • E WIT THE CALIFORNIA CONTRACTORS STATE LICENSE <br />, WORKERS C. , . N • TION • - <br /> <br />MINIM • ' 41441C1) Nis :. - C.:4 N.QTICE REQUIRED FO I <br />TITLE <br />THE WORK WILL BE DONE <br />I ALSO CERTIFY <br />BOARD AND THAT <br />KET1' PLEA <br />IC‘-\*Ns <br />IN ACCORDANCE <br />THAT MY REQUIRED <br />I AM IN COMPLIANCE <br />CALL (209) 95*769/1 <br />DATE 2.., <br />WITH <br />LICENSE <br />WITH <br />k <br />1,2, <br />SAN <br />IS <br />ALL <br />z:\ <br />1,1 1% <br />SIGNED <br />\ ,...........b.... --..,......, <br />A ...t....., \ <br />SEE ATTACHED M 4 P <br />c4 <br />tye; :SS32100V ails AljVC)/Fil (21-1/N co u <br />LTH NMEN r NTy DEPA RT44( <br />1 NT <br />MAR 1 1 <br />421 <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.s ov.or /ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />Application Accepted By <br />Grout Inspection By <br /> <br />Pump Inspection By Date <br /> <br />Soil BoringtV,spection By r Date 3 6/.2 <br /> <br />COMMENTS — I I t- jilph 1.7E :;t-r. L , : r . <br />Area / Employee 10# <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth <br />1 <br />DEPARTMENT USE ONLY <br />L.. 2 Date 'L:-/ <br />Date <br />ft <br />PE <br />Codes <br />SC <br />Info <br />Received Check#, <br />. ,Cash <br />Amount <br />Remitted i Date <br />Permit! <br />Service Plesue9.y. <br />Invoice # Weil ID# <br />' 13 7) 1 &--0 /It- Vie--- I/ .J )1, 311,1121 tAiVa) Li 1,1(41 <br />n . <br />1212-3101D WELL /PUMP PERMIT <br />EnD 43-06 6,11.2019