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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 m .slgov.org/ena tXPIKtb T YEAR FROM DATE ISSUED <br />JOB ADDRESS 8086 State Route 99 Cm/7jp Stockton/CA/95215 <br />CROSS STREET Kingsley Road ' - r (. APN 181-14-021 PARCEL SIZE 101.75 LAND USE APPLICATION # - <br />OWNER NAME CHI/Acquisitions CA, L.P. PHONE - <br />OWNER ADDRESS 527W. 7th Street, Suite 200 CrrY/STATEMp Los Angeles, CA, 90014 <br />ENGEO Incorporated PHONE 2094835.0610 <br />ADDRESS 17278 Golden Valley parkway CITY/STATEIZIP Lathrop/CA/95330 <br />SUBCONTRACTOR/CONSULTANT West Coast Exploration PHONE 209-985.7541 <br />SUBCONTRACTORICONSULTANT ADDRESS P.O. Box 133 CITYISTATEIZIP Escalon/CA/95320 <br />LICENSE EC -57 ❑C-61 ❑ D-09 ❑Other NUMBER 870761 EXPIRATION DATE 1/31/2022 <br />BILLING PARTY: F --OWNER ✓❑CONTRACTOR ❑SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: 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 />❑MonitoringWell(s) #of wells []SoilBodng(s) #of borings nv Geotechnical 6 sof borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary Air Rotary Hr Auger Cable Tool Push Point ❑ Other <br />Proposed Well Depth 30 ft Excavation 4 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth it <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth 3b it ❑✓ Neat Cement (94 Ib bagy3-10 gal water) Sand Cement Sack mixt/ gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped [Z]Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width it Length it Thick in Christy Box Stove Pipe <br />PUMP Submersible Turbine Other HP Pump Set it 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 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 />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNEDLauren Becker <br />TITLE -Staff Engineer DATE 7/6/2021 <br />DEPARTMENT USE ONLY <br />i <br />Application Accepted By -e!=—W Date 7 .7 / Area CyC� Employee ID# <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date 262 -'*o l Constructed Veil Dept ft <br />�OMMFNTS 1-r r-kPr 4.4- -i 1L4Vt o PP or QYcdLlrL k PYlI�iJ)'1,{-Q1141. '' . +re'jV)"1P <br />EHD 43-06 6/11/2019 I 5"I f 412 X 313 7 WELL /PUMP PERMIT <br />