Laserfiche WebLink
DEPARTMENT USE ONLY <br /> Date 415-4 1 <br />Date <br />Date ,5"/I-V,202.1 <br />WELLJPUMP 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 />JositsooREss 9770 E Eight Mi 1P Rd uremp,51-ockton.CA 95212 <br />CROSS STREET Ppzzi Rd APN 08902050 PARCEL SIZE 30 A FLAN -.0 USE APPLICATION # <br />OWNER NAME Podesta 1. Bros PHONE <br />OWNER ADDRESS 8000 N poripsta T,n CtTY1STATElZlPLindcn CA 9 5 3 6 <br />Purviance Drillers, INC PHONE 209-887-3554 CONTRACTOR <br />cmisTAThimpLinden CA 95236 CONTRACTOR ADDRESS P.O. Box 64 <br />SUBCONTRACTOR/CONSULTANT PHONE <br />SUBCONTRACTOR/CONSULTANT ADDRESS CITY/STATE/ZIP <br />= C-61 1 D-09 _ Other NUMBER 377923 EXPIRATION DATE 7/31/21 LICENSE k C-57 <br />BILUNG PARTY: Li OWNER !: CONTRACTOR SUBC0IffRACTOR/CONSULTANT <br />DomeSTic WELL SAMPLING: 17 General MineraliColiform Bacteria (4391) E Dibromochloropropane (4392) IT Arsenic (4393) <br />INTENDED USE Domestic/Private ICIrrigation/Agricultural r_s. Industrial F1 Water Quality Monitoring [3 Soil Sampling/Characterization <br />1 Public Water System <br />If cliffenmt from Owner Water System Name Contact name or Phone Number <br />TYPE OF WORK 2 New Well Ii Replacement Well = Well Alteration/Modification 2 Other <br /> <br />Ti Monitoring Well(s) # of wells Soil Boring(s) # of borings Geotechnical <br /> 11 of bonngs <br />Out-Of-Service Well Out-Of-Service Well Renewal Ui Cross-Connection Repair <br /> <br />7 New Pump *Pump Replacement 2 Pump Repair Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method 2 Mud Rotary .: Air Rotary Li Auger IT Cable Tool Push Point Other <br />Proposed Well Depth ft Excavation in diameter [1 Open Bottom D Gravel Pack/Gravel Size in diameter <br />COnductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter in Thickness/Gauge/ASTM Schad Steel 1 Plastic Stainless Steel 1 Other <br />Grout Seal Depth ft IT Neat Cement (94 lb bag15-10 gal water) Sand Cement sack mixl7 gal water <br />__: Bentonite (20% solids) D Other <br />Grout Placement Method 2 Pumped Free Fall I Other L Retardant / Accelerator (name) <br />PEDESTAL Installed By ii Driller .2. Pump Contractor LU Other <br />Concrete Pedestal :Dimensions: Width ft Length ft Thick in Christy Box I Stove Pipe <br />PUMP Ui SubmersibletFurbine 1 Other HP —I 6 Pump Set ft Standing Water Level 1 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 UCENSE BOARD AND THAT I AM IN COMPUANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />&misc.? .i.1414-0-Af-4 TITLE k <br />"!7"-T.-7. Dir:17C7. P77r,71.,:PF7.- "11'.7 -7" C 5,1 1. f`ar19117)5n-797 , <br />DATE fr - 7 <br />-NCVnr\-- k-k-A e., <br />0 <br />-e 11 <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By Date <br />COMMENTS <br />Area ifiC / Employee IDft <br />SPECIAL Well Permit <br />El WAIVER Received <br />Constructed Well Depth ft <br />PE <br />Codes <br />SC <br />Info <br />Received ChecIdN <br />,Cash <br />Amount <br />Remitted Date d " _I <br />Pennit/ <br />Ice . .W.r. .Regy.est* Invoice If Well IDN <br />013e, L' , 0 ‘dk._ ) y-- 1 7 7 1 -11- 74 v4q1o9 vi 1 <br />Ii <br />EHD 43-08 6/11/2019 <br />WELL /PUMP PERMIT <br />1233-o17-