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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 />ADDRESS <br />hd EXPIRES 1 YEAR FROM DATE ISSUED <br />CITY21P <br />STREET A T APN 06903037 PARCEL SIZE 142-1 ac LAND USE APPLICATION # <br />NAME METROPOLITAN WATER DISTRICT OF SOUTHERN CALIFORNIA PHONE (213) 217-6000 <br />ADDRESS 700 ALAMEDA ST Crry/STATE/ZIP LOS ANGELES, CA 90012 <br />kCTOR GREGG DRILLING & TESTING PHONE (925) 313-5800 <br />kCTORADDRESS 950 HOWE ROAD CrrY/STATE/ZIP MARTINEZ, CA 94553 <br />SUBCONTRACTOR/CONSULTANT AECOM PHONE 916.207.3053 <br />SUBCONTRACTORICONSULTANT ADDRESS 2020 L ST, SUITE 400 CIY/STATE/ZIP SACRAMENTO, CA 95811 <br />LICENSE XC -57 C-61 D-09 Other NUMBER 1044456 EXPIRAMONDATE 9/30/22 <br />BILLING PARTY: OWNER CONTRACTOR >e 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 >CSoil 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 Well(s) # of wells Soil Boring(s) # of borings >CGeotechnical 116 # of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />New rump rump IKeplacement rump Kepalr raise vveu casing <br />WELL CONSTRUCTION <br />Drilling Method Mud Rotary r Rotary Auger Cable Tool Push Point Other SONIC <br />Proposed Well Depth 1�- 0 Excavation _& in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameteri2SICkn=ss/Gauge/ASTM Schad Steel Plastic Stainless Steel Other <br />Grout Seal Depths 4 `v1 Neat Cement (94 1b bbag6 10 gal water) r� Sand Cement sack mix17 gal water <br />Bentonite (20% solids) Other ilE1Pi 1°11t►K� <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 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 />MINIMUM48HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED N1�- <br />�� Z-94� TITLE Project Manager DATE 02/24/2021 <br />SPN <br />Qwtawca d fthul-, <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring ns ctio <br />COMMENTS as a <br />DEPARTMENT USE ONLY <br />L� Date 3 f d <br />Date <br />i Date <br />AreaLl Aq 9 Employee ID# DA <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth fl <br />U_1 <br />g <br />A <br />m <br />N <br />•pq yM <br />RCC FNr <br />�qR � VFD <br />� ?0 <br />gQC1 ?I <br />Epq�My T° �NTy <br />MFNr <br />EHD 43-06 6111/2019/ 07 / — /�/M-1][�� WELL (PUMP PERMIT <br />1111-414 <br />