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C <br />1 1 <br />1456 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 -6232 (209) 468-3420 <br />NUN-KEFUNDABLE PERMIT www.sjgov.orgiena LAVIKtS 1 YEAR FROM UATE ISSUED <br />JOB ADDRESS 27505 E. Carter Rd. c,TY/ZI. Escalon/95320 <br />CROSS STREET ESCalon-Bellott�,a Rd. _ APN 187-26-003 _____PARCEL SIZE 45.23 LAND USE APPLICATION <br />OWNER NAME Mell-o_Ran_ch=dared PHONE 573-3748 _ <br />OWNER ADDRESS PQ_Box_22CRYISTATEIZIP Escalon/95320 <br />CONTRACTOR Delta Pump Co. PHONE 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California St. CITYISTATEIZIP Stockton/CA/95203 <br />SUBCONTRACTOR/CONSULTANT <br />SUBCONTRACTORICONSULTANT ADDRESS <br />LICENSE I C-57 XC -61 D-09 Other <br />BILLING PARTY. OWNER CONTRACTOR <br />PHONE <br />CITYISTATEIZIP <br />NUMBER 1055434 EXPIRATION DATE7/31/2023 <br />1 ! SUBCONTRACTORICONSULTANT <br />DOMESTIC WELL SAMPLING: -1 General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) -1 Arsenic (4393) <br />INTENDED USE - DomesticiPrivate Xlrrigation-Agricultural - Industrial - Water Quality Monitoring F Soil SamplingiCharacteLz�on <br />I Public Water System PP YMA r <br />Irdiirerent ricw Cw,v i. bWrtei Systern NdFne •�:ontacl Name or �honc+Number �^ r �, V <br />TYPE OF WORK LI New Well I Replacement Well Well Alleration!Modification Other <br />n Monitoring Wells) # of wells - Soil Borings) 0 nt bongs I Geotechnical <br />-�SU� I U 2021 <br />I Out -Of -Service Well Out -0f -Service Well Renewal Cross -Connection Repair <br />New Pump X Pump Replacement 1 Pump Repair Raise Well Casing SAN J <br />WELL CONSTRUCTION ({EANT)RCNMENC) NT <br />Dulling Method -, Mud Rotary L Air Rotary -1 Auger U Cable Tool Push Point Other H DEPA ENTAL <br />Proposed Well Depth It Excavation in diameter I i Open Bottom I I Gravel PackiGravel Size in diameter <br />J Conductor Casing in diameter I Conductor Casing Depth ft <br />Well Casing Diameter in Thickness 'Ga ugeiASTM Sched I � Steel Plastic I Stainless Steel Other <br />Giout Seal Depth It _ Neat Cement (941b bag/5- 10 gal water) _ Sand Cement sack m 17 gal mater <br />I Bentonite (20% solids) I Other <br />Grout Placement Method Pumped . I Free Fall Other I Retardant.: Accelerator (name) <br />PEDESTAL Installed By Driller Purnp Contractor Other <br />I Concrete Pedestal (Dimensions Width ft Length it Thick in Christy Box II Stove Pipe <br />Puny X Submersible _ Turbine Other HP 7.5 Pump Set 147 it Standing "Water Level 137 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 />Ivl :tea ,iv`s _,..: r iii aDVANCE NOTICE REQUIRtu FOR INSPECTIONS - PLEASE CALL (209) 953-7697. <br />SIGNED_ TITLE -Cf -0 DATE 8/12/2021 <br />DEPARTMENT USE ONLY <br />Application Accepted By C_ Z- Date �� J/� / Area q7 LJ rX Employee ID# A6-7 <br />Grout Inspection By _ Date I SPECIAL Well Permit <br />Pump Inspection By EM Date ! WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS l�O <br />PE <br />Codes <br />SC Received ChecAmount ate Permit] Invoice # <br />Info B Remitted Service R nest # <br />well ID# <br />Lam=X43-;rG 6111:-`019 ,"o-LL!Pufvp r'ER`Aii <br />