Laserfiche WebLink
Application Accepted By Date 4,-P) 4.:.;‘/ <br />Grout Inspection By <br />Pump Inspection By <br />Date <br />Date <br /> <br />1k <br /> <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 Earr HxzELTori AVENUE -STocmiote CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PERtarr ov.or. ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 3076 Turnpike Road crryizrp Stockton. CA 95206 <br />CROSS Smeer APN 16528054 PARCEL SUE 3_7ac LAND USE APPUCANON if <br />OWNER NAME Komalpreet Atwal pHow 209-836-9463 <br />OwtrElt ADDRESS PO Box 1169 CrrYISTATFJ7-19 Tracy, CA 95378 SS31;100V 3116 CONTRACTOR Atlas Technical Consultants LLC ptemE 415-272-8251 <br />CONTRACTOR ADDRESS 2001 Crow Canyon Rd, Suite 200 CrnISTATE/Zie San Ramon, CA 94583 <br />SUBCONTRACTOR/CONSULTANT West Coast Exploration Inc. Meow 209-985-7541 <br />SUBCONTRACTORMONSULTANT ADOFtESS PO Box 133 CITYiSTATFJZIP Excalon, CA 95320 <br />LICENSE NIC-57 C-61 0-09 Other Nutiaat 870761 exinexrioNDAre 1/31/2022 <br />BILLING PARTY: OWNER VEONTRACTOR SUBCONTRACTOR/CONSULTANT <br />Doraesnc Weu_ SAMPUNG: General Mineral/Cc:Norm Bacteria (4391) " Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED Usc Domestic/Private Inigation/Agriciittural Industrial Water Quality Monitoring VSoil Sampling/Characterization <br />Public Water System <br />If rEfferent from Owner Water System Name Contact Name w Phone Number <br />TYPE OF WORK New Well Replacement Well Well Alteration/Mothficaticci <br />oodl <br />Other <br />Monitoring Well(s) # of wells Soil Boring(s) s or es VGeotechnical _ <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 Mud Rotary Air Rotary "Auger Cable Tool <br />Proposed Well Depth 5 to 40 it Excavation 5 In diameter Open Bottom Gravel PacIdGravel Size <br /> <br />Pus oint Other <br />in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Weil Casing Diameter In Minim ,auge/ASTM Schad Steel Plastic Stainless Steel NiOther N/A <br />G rout seal DeptilTOpTc73ottotiip Neat Cement (94 lb bag/5-10 gal water) Sand Cement sack mixrf gal water <br />Bentonite (20% solids Other <br />Grout Placement Method Pumpe Free Fall A Other /vervt P'( e <br />PEDESTAL. Installed By Driller Pump Contractor Other <br />Concrete Pedestal Diu . Width ft LeTKILh ft Thick in Christy Box Stove Pipe <br />EWE Submersible Turbine Other HP Pump Set ft Standing Water Level ft <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 UCENSE 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 />&mice <br /> _I 4 <br />Pkefi vkA- Dere - -2 I <br />MINIMU 1 43 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />If of borings <br />Retardant! Accelerator (name) <br />(fo <br />CA <br /> itsiC?(.8/v <br />la4/4?(JA/7), <br />DEPARTMENT USE •NLY <br />law." <br />Soil Boring Inspection By ale <br />COMMENTS /, ( 4 - 1 14 is <br />W11:111P Igfrt <br />Employee 10 <br />SPECIAL Well Permit <br />WAIVER Received <br />w•n Deptti <br />0 fl"prir fl1Q 30 Pert <br />PE <br />Codes <br />SC <br />Info <br />Received <br />B <br />cheekiii <br />AocaZi-t' <br />Amount Date 1 Remitt ed <br />Permit/ <br />s Invoice It Well ID8 <br />L l37) i.e, 0 t P-iii i? 5i 21 ';'-i <br />v ServIi.uca)reo <br />I <br />Au <br />1 <br />ENO 43-06 6111/2019 WELL /PUtaP PERIA/T <br />asls--701