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11 WELL/PUMP PERMIT <br />SAN JOAQEAS <br />UW COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 186a T HAZELTON AVENUE -STOCKTON CA SS206.6232 (209)488-3420 <br />RUN-KEFUNDABLE HERMIT w%WsJaov.orWehd <br />EXPIRES 1 YEAR FROM DATE ISSUE[ <br />Joe AntmEss 1651 E Grant Line Rd <br />clTy/zIP Tracy 195304 <br />CRose STREET N Chrisman Rd APN 213-070410-000 pARCEL SIzE6.3 Ac LANG USE APPLICATION / <br />OWNER NAME Marty Marilyn Trust <br />PHONE <br />OWNER ADDRESS 1681 E Grant Line Road <br />CITYISTATE/zP Tracy I CA 195304 <br />CONTRACTOR Exploration Geoservices <br />PHONE (408) 280-6822 <br />CONTRACTOR ADDRESSidmb iale V03 Al3&A4 <br />'tX CnY/STATErz p San Jose / CA /-*"2 $91%0 <br />110 <br />suaCQNTRACTOR1ComuLTANT Comerstone Earth Group <br />PHONE (408) 245-4600 <br />SUSCONrRACTOR/C00,13ULTANTAOQREss 1259 Oakmead Parkway <br />C"YISTATIEZIP Sunnyvale 1 CA / 94085 <br />LICENSE X C-67 I I C-61 13 D•09 1) Ogler <br />NUMBER 484288 EXPIRATION DATE 12131/2021 <br />BUTAO PARTY: I 1 OWNER 1: CONTRACTOR <br />X SUBCONTRACTOR/CONSIILTANT <br />DOMESTIC WFJ.L SAMPuNo: (I General Mineral/Coldorm Bacteria (4391) t: Dibromochloropropane (4392) 'i Arsenic (4393) <br />INTENDED USE n Oomestic/Prlvale 0 Inlgetion/Agricugurai I I Industrial I) Water QualityMonlforing X Sed Sampling/Cheracterizatien <br />I I Public Water System <br />UdE9e1on1 Som Oweer VAW Sysbm Namo C9Nad Name or Paaw Number <br />TYPE OF WORK I I New Well n Replacement Wkll n Well Alteration/Modification i I Other <br />11 Monitoring Welts) Sof WOOS n Sotl Bodng(s) r or bonegs X Geotechnical _ 3 of bertops <br />I I Out -Of -Service We[) I I Oul-Of-Service Wag Renewal 1: Cross -Connection Repair <br />rww rum Ke 1 ; I F -UMP Ke au P Raise Well Casing <br />WELL CONSTRUCTION Hollow Stem <br />DdlGng Method I I Mud Rotary n Air Rotary U Auger I I Cable Tod [ I Push Point I I Other <br />Proposed Well Depth 5 to 50 fl Excavation 8 In diameter U Open Bottom D Gravel PaWGrovel Size in diameter <br />t: Conductor Casing in diameter / Conductor Casing Depth It <br />Well Casing Diameter _ in ThidmessfGauge/ASTM Schell n Steel I I Plastic I I Stainless Steel U Other <br />Grout Seal Depth S `� It X Neal Cement (94 1b beg-- 10 gal wafer) 1) Sand Cement sack r4xi7 gal water <br />I I Bentonite (20% solids) a Other <br />Grout Placement Method (I Pumped 1 I Free Fag X) Other Tremle Grout I I Retardant / Accelerator (name) <br />IPEor;&TA Installed By U Driller I I Pump Contractor I I Other <br />n Concrote Pedestal UDimenelons: VNdth ft Length ft Thick in I I Christy Box I I Stove Plpe <br />lP r a 1' Submers' bU Turbine " Other HP Pump Set R Standing Water Level77-7 R <br />I HEREBY CERTIFY VCT I HA PR PARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />JOAQUIN COU OINAN ST TE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AN AC THE OLIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS CE TIO WS - <br />MINIM 48 ANCE NOTICE REQUIRED FO SID �h ,,PLEASE CALL (209)) 943-717 <br />SIONEO TITLE `` ;C `��,„, (o DATE 1% %U %01`\ <br />DEPARTMENT USE ONLY <br />bcatbn ted B ` Date r' �� v S l" z / <br />APP nspep y Area-� Employee lDO <br />Grout Inspection By a�� 1 f - Date s PECIAL ell PeITf►It <br />Pump Inspection By Date 1. WAIVER Received <br />Sod Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />PE Sc Re"Wed Checktll Amount Date Permit/ Invoke p well ION <br />Codes Info Cas Remitted erviceR usatll <br />k137„2 s'5 t/427 <br />EH043-06 6/1112019 f _ 4 WELL RUMP PERMIT <br />.µ <br />