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i <br /> r r r <br /> WELL/PUMP 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 /> JOB ADDRESS 4300 Mariposa Rd CITylZIP Stockton/95215 m <br /> D <br /> CROSS STREET Carpenter Rd APN 179-56-021 PARCEL SIZE 6.68 Acres LAND USE APPLICATION# o <br /> A <br /> m <br /> OWNER NAME Gagandeep Singh PHONE 209.992-0140 <br /> fA <br /> OWNER ADDRESS 508 Southeriand Drive CITY/STATE/ZIP Stockton/CA/95210 <br /> CONTRACTOR West Coast Exploration Ince PHONE 209-985-7541 <br /> CONTRACTOR ADDRESS P.O.Box 133 CITY/STATE/LP Escalon/CA/95320 <br /> SUBCONTRACTOR/CONSULTANT CTE CAL Inc PHONE 209-543-1799 <br /> SUBCONTRACTORICONSULTANT ADDRESS 4230 Kiernan Ave Ste 150 CITY/STATEIZIP Modesto/CA/95356 <br /> LICENSE x C-57 C-61 D-09 Other NUMBER 870761 EXPIRATION DATE 1-31-2022 <br /> BILLING PARTY: OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General MineraUColiform 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/Modiftcation Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings x Geotechnical 2 #of borings <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 x Auger Cable Tool Push Point Other <br /> Proposed Well Depth 12 it Excavation 4 inches 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 Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth11 2 _ft x Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped x Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP 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 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 /> M/II��N��I�MU�M�4/J8 HOUR[ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED />rCJ.l1t:FA.(' c]/LG-(7 TITLE Stall Geologist DATE 6/30/21 <br /> S EJEJ JAITIT ACHE D <br /> 11,12 <br /> q yM <br /> cF��NT <br /> 0 FO <br /> 8,90 <br /> FAtp <br /> DEPARTMENT USE ONLY �/�y <br /> Application Accepted By'� Date 7 i7 Area f L7 C Employee ID# / &) <br /> 7/j <br /> Grout Inspection By ' Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By D to J Constructed Well Depth ft <br /> COMMENTS�f P�`A rrW Dt r H y�. /pT -IM Wv/P piye til 4:� <br /> PE SC Received Check#/ Amount Date Permitl Invoice# Well ID# <br /> Codes Info Cash Remitted ce Reguest# <br /> 37.1 o <br /> EHO 43.06 6/11/2019 12 <br /> Oqb 7Y5- WELL/PUMP PERMIT <br />