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JOB ADDRESS 1880 E. Hammer Lane CI-Nam Stockton / 95210 <br />CROSS STREET Montauban Avenue APN 094-280-120 PARCEL Sim 2.80 LAND USE APPLICATION # <br />OWNER NAME NJ Investments Stockton LLC /Client: Architectural Design Guild pHoNEAlex Bley; Ph: 314.644.1234 <br />OWNER ADDRESS 1156 Tanglewood Way /Client: 2710 Sutton Boulevard crryisTATEizip San Mateo, CA 94403/ Client: St. Louis, M <br />CONTRACTOR V & W Drilling, Inc. - Contact: Karli Stroing <br />PHONE 209.469.7700 <br />CONTRACTOR ADDRESS 1133 Blackhurst Drive Crry/SrArEIZip Galt, CA 95632 <br /> <br />SuscorfrnAcTort/CoNSuLTANT Condor Earth - Contact: Ron Skaggs, Principal Engineer, CA GE2295 NONE 209.938.1040 <br />SUBCONTRACTOR/CONSULTANT ADDRESS 188 Frank West Circle, Ste. 1 CrrY/STATE/Zip Stockton, CA 95206 <br />LICENSE X C-57 C-61 D-09 Other <br />BILLING PARTY: OWNER X CONTRACTOR <br />NUMBER 720904 <br />SUBCONTRACTOR/CONSULTANT <br />EXPIRATION DATE 04/30/2022 <br />Retardant / Accelerator (name) <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br />Proposed Well Depth 10 to 20 ft Excavation 4.5 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 full depth ft Neat Cement (94 lb bag/5-10 gal water) <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped Free Fall X Other Tremie <br />Sand Cement sack mixI7 gal water <br />ft Thick <br />PEDESTAL <br />in Christy Box Stove Pipe <br />Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length <br />HP Pump Set ft Standing Water Level ft Submersible Turbine Other <br />M II,j104. HOU -Ajoa, <br />11P7f,' <br />REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />TITLE Project Coordinator DATE 04/13/21 SIGNED <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - SrocicroN CA 95205-6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />DOMESTIC WELL SAMPUNG: 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 />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 /> <br />Monitoring Well(s) # of wells Soil Boring(s) # of borings X Geotechnical <br />Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br />New Pump Pump Replacement Pump Repair Raise Well Casing <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 />DEPARTMENT USE ONLY <br />Date I Areacystuki JP Employee I0W DA <br /> <br />Grout Inspection By Date <br /> <br />Pump Inspection By Date WAIVER Received <br /> <br />Soil Boring Inspection By Date 5/1/7024 Constructed Well Depth ft <br />COMMENTS <br />PE <br />Codes <br />SC <br />Info <br />Received <br />B <br />Check#/ <br />Cash <br />Amount <br />Remitted Date, Permit/ <br />Service Re ue t # Invoice # Well ID# <br />437R )50 Vi-"`" # 6°1 L149-0/11 W 004- <br />2 # of borings <br />Application Accepted By <br />SPECIAL Well Permit <br />WELL /PUMP PERMIT EHD 43-06 6/11/2019