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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 />-r�crury VAGLG rCKMII <br />Joe ADDRESS 1605 East March Ln <br />CROSS STREET West Ln <br />OWNER NAME Store Spe Corinthian LLC <br />OWNER ADDRESS 1605 East March Ln <br />CONTRACTOR Rockridge Geotechnical. Inc. attn Devin Landkamer <br />CONTRACTOR ADDRESS 270 Grand Avenue <br />SUBCONTRACTOR/CONSULTANT Middle Earth GeoTeSling, Inc. <br />SUBCONTRACTOR/CONSULTANT ADDRESS 954 Lemon Street <br />LICENSE SIC -57 C-61 D -C9 Other <br />BILLING PARTY: OWNER V0000NTRACTOR <br />APN 096-140-48 <br />d EXPIRES 1 YEAR FROM DATE ISSUED <br />CITY/ZIP Stockton 95210 <br />PARCEL SIZE 2 acres LAND USE APPLICATION # <br />PHONE <br />CITY/STATE/ZIP Stockton, California 95210 <br />PHONE 970-215-7740 <br />CITY/STATE/ZIP Oakland, California 94610 <br />PHONE 714-633-5025 <br />CITY/STATE/ZIP Orange, California 92867 <br />NUMBER 899451 EXPIRATION DATE 6/30/2023 <br />SUBCONTRACTOR/CONSULTANT <br />UOMESTIC WELL SAMPLING: General Mineral/COliform Bacteria (4391) Dibromochloropropane (4392) Arsenic 143931 <br />NTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />It different from Ower Water System Name Contact Name or Phone Number <br />_ ess auge Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth 50-100 ft v0p <br />Neat Cement (94 /b bag/5-10 gal wafer) Sand Cement sack mix/7 gal <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped VFree_Fall y Other tremie if applicable Retardant /Accelerator (Hamel <br />PEDESTAL N/A Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions Width ft Length ft Thick in Christy Box UMStove Pipe <br />PP NIA Submersible Turbine Other HP Pump Set ft Standing Water Level ft <br />1 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 COM NSATION LAWS. <br />MINIM 8 HOUR NCE NOTI REQUIRED F INSPIE1CCTIO PL ASE CALL (209))t953-7697 <br />SIGNED TfTLYIt I r 1 V�Lu.fl4 Ll-yDATE <br />T� D/EPARTMENTT U S7 <br />Application Accepted By C' f'�—C� Date Area ��1 USI Employee ID# D_ <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date l) ((D Constructed Well Depth ft <br />COMMENTS <br />�FENT <br />V ED <br />02 2021 <br />MENTA UN Ty <br />PARTrNENT <br />PE SC Received <br />Codes Info I 8 <br />.— vrcn nepiacemem well <br />Well Alteration/Modification <br />Other <br />1 <br />Monitoring Well(s) # of wells <br />Soil Boring(s) rt of borings <br />VGeotechnical 3 it of borings <br />Out -Of -Service Well <br />Out -Of -Service Well Renewal <br />Cross -Connection Repair <br />New Pump Pump Replacement <br />Purnip Repair <br />Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method <br />Mud Rotary Air Rotary Auger <br />Cable Tool Push Point <br />V Other Cone Penetration Tests <br />Proposed Well <br />Depth 50-100 ft Excavation 17 <br />in diameter Open Bottom <br />Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter <br />/ Conductor Casing Depth <br />ft <br />N/A Well Casing <br />Diameter in Thickn /G /­. <br />_ ess auge Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth 50-100 ft v0p <br />Neat Cement (94 /b bag/5-10 gal wafer) Sand Cement sack mix/7 gal <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped VFree_Fall y Other tremie if applicable Retardant /Accelerator (Hamel <br />PEDESTAL N/A Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions Width ft Length ft Thick in Christy Box UMStove Pipe <br />PP NIA Submersible Turbine Other HP Pump Set ft Standing Water Level ft <br />1 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 COM NSATION LAWS. <br />MINIM 8 HOUR NCE NOTI REQUIRED F INSPIE1CCTIO PL ASE CALL (209))t953-7697 <br />SIGNED TfTLYIt I r 1 V�Lu.fl4 Ll-yDATE <br />T� D/EPARTMENTT U S7 <br />Application Accepted By C' f'�—C� Date Area ��1 USI Employee ID# D_ <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date l) ((D Constructed Well Depth ft <br />COMMENTS <br />�FENT <br />V ED <br />02 2021 <br />MENTA UN Ty <br />PARTrNENT <br />PE SC Received <br />Codes Info I 8 <br />Check#/ Amount <br />ash Remitted <br />Date <br />Permit] <br />Service Re ueSt # Invoice # Well ID# <br />1 <br />o <br />I a; <br />EHD 47 -UG 6/111I019 <br />1M1'ELL/PUMP PERMIT <br />Z <br />