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r <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 -6232 (209) 468-3420 <br />NUN-KEFUNDABLE PERMIT www.sjgov.org/enci tAYIKLb l TEAR FROM DATE ISSUED <br />JOB ADDRESS 424 East 9th Street clnrz,P Stockton, CA 95206 <br />T <br />CROSS STREET S San Joaquin St APN 16706001 PARCEL SIZE 23 aCref AND USE APPLICATION # <br />OWNER NAME City Of Stockton, Public Works Department PHONE 209-937-8411 <br />OWNER ADDRESS 22 E. Weber Avenue, Room 301 CITYISTATE/ZIP Stockton, CA 95202 <br />CONTRACTOR Geocon Consultants, Inc. PHONE 916-852-9118 <br />CONTRACTOR ADDRESS 3160 Gold VaUelly��Driye, Suite 800 CITY/STATE/ZIP Rancho Cordova, CA 95742 <br />SUBCONTRACTOR/CONSULTANT VBrW Drillmg, Inc' PHONE 209-469-7700 <br />SUBCONTRACTORICONSULTANT ADDRESS 1133 Blackhurst Drive CITY/STATE/ZIP Galt, CA 95632 <br />LICENSE R C-57 C-61 <br />BILLING PARTY: OWNER <br />D-09 <br />Other NUMBER 720904 EXPIRATION DATE 4/30/2022 <br />CONTRACTOR SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochioropropane (4392) Arsenic (4393) <br />INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring A 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 />Monitoring Well(s) # of wells Soil Boring(s) # of borings % Geotechnical 4 # of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />Drilling Method Mud Rotary Air Rotary g Auger Cable Tool Push Point Other <br />Proposed Well Depth 10&20 ft Excavation Sri 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 Schad Steel Plastic Stainless Steel Other <br />Grout Seal Depth 10&20 ft K Neat Cement (94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped g Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width It Length ft Thick in Christy Box Stove Pipe <br />PUMP Submersible Turbine Other HP Pump Set ft Standing Water Level It <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 />11W�UM 48,lt=R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br />TITLE TITLE Sr. Staff Engineer DATE 3/24/2021 <br />, <br />(/1 <br />g <br />A <br />m <br />N <br />DEPARTMENT USE ONLY 1/,� /'' <br />Application Accepted By �+ LL Date 3 �S d Area SIV•�:I�G 0A Employee IN 45 <br />Grout Inspection By Data Lk I 6 SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring In By Date Construe ed Well nnlIepth ft <br />COMMENTS • I fentn ie pipe, '10 @ uS 1 E r. My) hlCrl 6Y lS PH40U n fjeLa 1. <br />EHD 43-06 6/11/2019 �n_ /� � ����� WELL (PUMP PERMIT <br />—,Vr <br />