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WELUPUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 NON-REFUND A LE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED Joe ADDRESS Paradise Road Crrv21P Lathrop,CA 95330 m CROSS STREET Stewart Road APN 21312006 PARCEL S¢E 468.61 LAND USE APPLICATION# OWNER NAME River Islands Development LLC PHONE 209-879-7900 y OWNER ADDRESS 73 Stewart Road CITYISTATE/ZIP Lathrop,CA 95330 CONTRACTOR West Coast Exploration PHONE 209-985-7541 CONTRACTOR ADDRESS PO Box 113 CITY/STATE(ZIP Escalon,CA 95320 SUBCONTRACTOR/CONSULTANT ENGEO Incorporated Osedore@engeo.com) PHONE 925-719-0822 SUSCONTRACTOR/CONSULTANT ADDRESS 17278 Golden Valley Parkway CITY/STA7E/7JP Lathrop,CA 95330 LICENSE IXC-57 ❑C-61 D D-09 D Other NUMBER 870761 EXPIRATION DATE 01)31)2022 BILLING PARTY: D OWNER ❑CONTRACTOR D SUBCONTRACTORICONSULTANT DOMESTIC WELL SAMPLING:D General Mineral/C011form Bacteria(4391)0 Dibromochloropropane(4392)0 Arsenic(4393) INTENDED USE ❑DomestldPdvate ❑Irrigation/Agricultural ❑Industrial ❑Water Quality Monitoring ❑Sol�Sampllng/C�haractedza�tlon �D Public Water Systemdifferent from Owner: Water System Name Contact Nem TYPE OF WORK D New Well ❑Replacement Well D Well Alteratlon/Modification D Other DMonitoring Well(s) #of wells DSoil Boring(s) Nofboring, C{Geotechnical #ofbodngs 0 Out-OfServlce Well D Out-Of-Service Well Renewal ❑Cross-Connectlon Repair ❑New Pump ❑Pump Replacement D Pump Repair D Raise Well Casing WELL CONSTRUCTION Drilling Method ❑Mud Rotary 0 Air Rotary X Auger ❑Cable Tool ❑Push Point 0 Other Proposed Well Depth 10-30 it Excavation 4 In diameter ❑Open Bottom ❑Gravel Pack/Gravel Size In diameter 0 Conductor Casing In diameter / Conductor Casing Depth ft Well Casing Diameter_In Thickness/Gauge/ASTM SchadD Steel ❑Plastic ❑Stainless Steel D Other Grout Seal Depth 10-30 ft [{Neat Cement(94 lb bag/5-f0 gal water) ❑Sand Cement sack m1x!7 gal water ❑Bentonfte(20%solids) ❑Other Grout Placement Method ❑Pumped D Free Fell ❑Other ❑Retardant/Accelerator(name) PEDESTAL Installed By ❑Driller 0 Pump Contractor ❑ Other D Concrete Pedestal DDlmenslons:Width ft Length ft Thick In ❑Christy Box 0 Stove Pipe PUMP ❑Submersible❑Turbine ❑Other HP Pump Set ft Standing Water Level fl I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 SIGNED Jason Sedore TITLE Staff Geologist DATE 07/26/2021 ------------------------------ --------------------------------- ------------------------------ ------------------------------ --------------- ----- —it---- YMENT SEE ATTACHED CEIVED 0 3 2021 5 NJ AQUIN COUNTY IRONMENTAL H L HDEPARTMENT // DEPARTMENT USEONLY I //�� Application Accepted By ��L L Date Y / Area S `'711 ro Employee ID# A S Grout Inspection By Date 0 SPECIAL Well Permit Pump Inspection By Date ❑ WAIVER Received Soll Boring I Spectlon By gale Constructed Well Depth ft CQMMENTS rP rvtl4L P r I aP �n h(/ �i''P(/ 1 F cla1r�yj b FPP ti �"p PE SC Received Check#/ Amount Permit/ Codes Info Cash Remitted Dat Service Re nest# Invoice# Well ID# 7 50 2 Z 2 EHD43-08 6/11/2019 WELL/PUMP PERMIT