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CONTRACTOR ADDRESS <br /> <br />CITY/STATE/ZIP <br />SUBCONTRACTOR/CONSULTANT <br /> <br />PHONE <br />NUMBER <br />0222 9.1'406.S. Bird Road Tracy, CA JOB ADDRESS CITY/ZIP <br />CROSS STREET 1-S•ff0 APN 26508015 PARCEL SIZE 271 1 ac. LAND USE APPLICATION # N/A <br />OWNER NAME Granite Construction Company PHONE 916-855-4400 <br />OWNER ADDRESS P.O. Box 15287 CITY/STATE/ZIP Sacramento, CA 95851 <br />CONTRACTOR <br /> <br />PHONE <br />SUBCONTRACTOR/CONSULTANT ADDRESS <br />LICENSE I C-57 C-61 D-09 I Other <br />CITY/STATE/ZIP <br />EXPIRATION DATE <br />BILLING PARTY: X OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT <br />ii Conductor Casing in diameter / Conductor Casing Depth ft <br />Other _ Retardant / Accelerator (name) Grout Placement Method L Pumped _ Free Fall <br />PEDESTAL Installed By 7 Driller LI Pump Contractor I Other <br />in Christy Box Stove Pipe ft Thick Concrete Pedestal Dimensions: Width ft Length <br />ft Standing Water Level ft Submersible Turbine r Other HP Pump Set PUMP <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 />MINIM t1:1 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />Z7¢1°14.t3+ TITLE Environmental Coordinator II DATE 3/25/2020 SIGNED <br />WELL CONSTRUCTION <br />Drilling Method n Mud Rotary I Air Rotary ci Auger LI Cable Tool E Push Point E Other <br />Proposed Well Depth ft Excavation in diameter _I Open Bottom II Gravel Pack/Gravel Size in diameter <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched Ii Steel CI Plastic Stainless Steel IL Other <br />Grout Seal Depth ft I ' Neat Cement (94 lb bag/5-10 gal water) I Sand Cement <br />Bentonite (20% solids) C Other <br />sack mix/7 gal water <br />PAY <br />ED <br />111AR 3 1 2620 <br />Acr,, <br />'17 DEPArTAL TmENT <br />ee <br />SA <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STocKtron CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />DOMESTIC WELL SAMPLING: _ General Mineral/Coliform Bacteria (4391) - Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE Domestic/Private Irrigation/Agricultural X 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 <br /> <br />Well Alteration/Modification Other <br />Monitoring Well(s) # of wells Soil Boring(s) of borings Geotechnical <br /> If of borings <br />,X Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br />C] New Pump Pump Replacement 1 Pump Repair Raise Well Casing <br />DEPARTMENT U ENLY <br />Application Accepted By 6RZZ' Date 3 g/ 1040 Area C erg Employee ID# b A <br />Grout Inspection By 4440.nte <br /> <br />Pump Inspection By Date I WAIVER Received <br /> <br />Soil Boring inssection By Date Constructed Well Depth ft <br />COMMENTS latter feroAlni f cpr Nve (3-3yeAss the D;ter,l-gr May C 6111 at the t I. well to be Froterly Abisncionted• Well is tee(/re_ nd <br /> <br />I-0 As r-vva eff <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By.. <br />Check#1 <br />Cash, _ <br />Amount <br />Remitted ate Permit/ <br />Service Request # Invoice # Well ID# <br />LiWi 178 L/4-- 0216',e' #12? 4/71)WVOCA-Wwq2 :SS32100V 311S WELL /PUMP PERMIT /e)6 sq 2_7 6 6 END 43-06 6/11/2019