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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 />INVI I-KEFUNDABLE MERMII <br />Joe ADDRESS 231 - 399 Port Rd 2 <br />CROSS STREET See "Job Address" above <br />OWNER NAME Port of Stockton <br />OWNER ADDRESS PO Box 2089 <br />APN 14502004 <br />Taber Drilling <br />ADDRESS 536 Galveston St <br />3NTRACTOR/CONSULTANT <br />:)NTRACTOR/CONSULTANT ADDRESS <br />SE X C-57 C-61 D-09 <br />IG PARTY: OWNER <br />Other <br />'C^ CONTRACTOR <br />t/CY111I T T EAK FROM LIA 11: 155ULU <br />CITY/ZIP Stockton 95203 <br />CEL SIZEI62.3 AcresLAND USE APPLICATION # N/A <br />PHONE (209)946-0246 <br />CITY/STATE/ZIP Stockton, CA 95201 <br />PHONE (916)371-8234 <br />CITY/STATE/ZIP West Sacramento, CA 95691 <br />PHONE <br />CITY/STATE/ZIP <br />NUMBER 969927 <br />29. SUSCONTRACTOR/CONSULTANT <br />ExPIRATION DATE February 29, 2020 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) - Dibromochloropropane (4392) Arsenic (4393) <br />VTENDED USE Domestic/Private Irrigation/Agricultural - Industrial - Water Quality Monitoring X Soil Sampling/Characterization <br />Public Water System N/A <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK New Well _. Replacement Well L Well Alteration/Modifcation X Other 3 Cone Penetration Tests <br />MonitoringWell(s) #of wells 0 Soil Boring(s) #of borings XGeolechnical 7 nor borings <br />Out -Of -Service Well D Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />rn <br />m <br />D <br />A <br />m <br />WELL CONSTRUCTION <br />T <br />yp�� <br />Drilling Method X Mud Rotary 1:1 Air Rotary Auger Cable Tool D Push Point X Other Cone Penetration Test (direct push') 0� <br />Proposed Well Depth 100 ft Excavation 5 in diameter a Open Bottom _ Gravel Pack/Gravel Size N/A in diameter <br />V <br />❑ Conductor Casing N/A in diameter / Conductor Casing Depth N/A ft ho <br />2019 <br />Well Casing Diameter N/A in Thickness/Gauge/ASTM Sched N/A C Steel I- Plastic 1 Stainless Steel Other <br />Grout Seal Depth 100 ft x Neat Cement (94 Ib bag/5-10 gal water) Sand Cement sack m <br />X Bentonite (20% solids) x Other Geotechnical borings and CPT holes will be backfilled (sealed) with bentonite grout or neat c <br />IN COUNTY <br />Grout Placement Method Pumped _� Free Fall x Other Tremle tube Retardant / Accelerator (name) HEA <br />ARETTAL <br />MENT <br />PEDESTAL Installed By Driller 1 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 />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 COMPENSATION LAWS. <br />OUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED 04�TITLE VP / Exploration Coordinator DATE 08.20.2019 <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS/IrCl <br />,I I <br />1.040-1 <br />1-04 <br />EALTH <br />ES <br />MENT U E NIL Y <br />Date v I Area EmployeeID#� <br />Date [' ) SPECIAL Well Permit <br />Date WAIVER Received <br />.,Da Constructed Well Depth k <br />I <br />y ./y ►,c`<r�� �Y1 z7snr�tr�0 Nq r)44j�i';% <br />Itern4ttePerm it/ <br />_M d <br />EHD 4306 6/1112019 WELL /PUMP PERMIT <br />