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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 /> NON-REFUNDABLE PERMIT www.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 26301 Hansen Road CITY/ZIP Tracy,CA 95377 m <br /> CROSS STREET None APN 20923-009 PARCEL StZE-68 acres LAND USE APPLICATION# o <br /> A <br /> OWNER NAME Sandeep Singh PHONE (209)513-0508 y <br /> OWNER ADDRESS 26301 Hansen Road CITY/STATE/ZIP Tracy,CA 95377 <br /> CONTRACTOR Taber Drilling PHONE (916)371-8234 <br /> CONTRACTOR ADDRESS 536 Galveston Street CITY/STATE/ZIP West Sacramento,CA 95691 <br /> SUBCONTRACTOR/CONSULTANT Klelnfelder Inc. PHONE 408-840-1038 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 380 North First Street,Suite A CITY/STATEIZIP San Jose,CA 95112 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 969927 EXPIRATION DATE 7/15/2022 <br /> BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTORICONSULTANT <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 /> Monitoring Wells) #of wells Soil Boring(s) #of borings x Geotechnical 10 #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(NO WELLS ONLY GEOTECHNICAL BORINGS) <br /> Drilling Method Mud Rotary Air Rotary x Auger Cable Tool Push Point Other <br /> Proposed Well Depth 10 ft Excavation 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 Depth IT, x Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix17 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped 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 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 /> MINjbI�U`=` I- =AE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED /�� Dan Dockendort TITLE Project Manager-Kleinfelder Inc. DATE 7/15/2021 <br /> RFgyM <br /> U� 1gTC Q <br /> Fp <br /> FAq�N CO�NTY <br /> MFNr <br /> I I L# <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area S Employee ID# AS <br /> Grout Inspection By Date �� SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Cas Remitted Service Request# <br /> va o a <br /> EHD 43-O6 6/11/2019 - /� �j-` I _ �� WELL/PUMP PERMIT <br />