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WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868(EAST HAZELTON AVENUE-STOCKTON CA 95205-6232 (209)468-3420 NON-REFUNDABLE PERMIT www.S Ov.or /ekd EXPIRES 1 YEAR FROM DATE ISSUED Ln JOB ADDRESS 3201 E.Morada Lane CrrY21P Stockton 95212 m n CROSS STREET Holman Road APN 124-300-11 PARCEL SIZE 13 acres LAND USE APPLICATION# O X m OWNER NAME College for Certain ll,LLC PHONE Cnn OWNER ADDRESS 100122nd Avenue,Suite 100 CITY/STATEIZIP Oakland,CA 94607 0 D CONTRACTOR Rockridge Geotechnical,Inc.attn Devin Landkamer PHONE 970-215-7740 Cr 1 CONTRACTOR ADDRESS 270 Grand Avenue CITY/STATE/ZIP Oakland,California 94610 D CD I 3 SUBCONTRACTORICONSULTANT Middle Earth GeoTesting,Inc. PHONE 714-633-5025 `m SUBCONTRACTOR/CONSULTANT ADDRESS 954 Lemon Street CITY/STATE/ZIP Orange,California 92867 LICENSE VC-57 U C-61 U D-09 U Other NUMBER 899451 EXPIRATION DATE 6/30/2023 BILLING PARTY: L!OWNER CONTRACTOR L SUBCONTRACTORICONSULTANT DOMESTIC WELL SAMPLING: ❑General Mineral/Coliform Bacteria,(4391)11 Di romochloropropane(4392)! �Arsenic(4393) INTENDED USE E. Domestic/Private C Irrigation/Agricultural ❑ Industrial ❑ W�ter Quality Monitoring VrSoil Sampling/Characterization Public Water System If different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK New Well ❑ Replacement Well ❑ Well Alteration/Modifidation ❑ Other Monitoring Wells) #of wells a Soil Boring(s) #of borings IvGeotechnical 4 #of borings Out-Of-Service Well U Out-Of-Service Well Renewal ❑ Cross-Connection Repair New Pump Pump Replacement ❑ Pump Repair G Raise Well Casing WELL CONSTRUCTION Drilling Method Mud Rotary L] Air Rotary ❑ Auger ❑ Cable Tool Push Point V Other Cone Penetration Tests Proposed Well Depth 50-100 ft Excavation 1.7 in diameter L Open Bottom U Gravel Pack/Gravel Size in diameter i Conductor Casing in diameter / Conductor Casing Depth ft N/A Well Casing Diameter_ in Thickness/Gauge/ASTM Sched ;C Steel C; Plastic Ci Stainless Steel I Other Grout Seal Depth 50-100 ft Neat Cement(94 Ib bag/5-10 gal water) ❑ Sand Cement sack mix17 gal water Bentonite(20%solid ❑ Other Grout Placement Method Li Pumped Free Fall */Other tremie if applicable ❑ Retardant/Accelerator(name) PEDESTAL N/A Installed By Li Driller ❑ Pump Contractor F! Other U Concrete Pedestal❑Dimensions:Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe PUMP N/A U Submersibleu Turbine U Other HP I L Pump Set ft Standing Water Level ft I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULL TIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AW ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS CO ENSATION LAWS. MINIM HQUF2 E NOTICE REQUIRED FOR I�' PECTI NS - PLEASE CALL (209) 953-7669712 J SIGNEDTITLE mDATE 'Z 1 i 6_1 r O i q R N T N y I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I DEPARTMENT USE ONLY Application Accepted By �GG Date i.� Dd I Area StU�k��i' Employee ID# Fre,V1 J, Grout Inspection By Date ❑ SPECIAL Well Permit Pump Inspection By Date WAIVER Received Soil Boring Inspection By r, pa\ n(A`,j Date (2 Z Z- Constructed Well Depth ft COMMENTS PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# Codes Info By ash Remitted Service Re nest# L13_7SO Ste- 1107 EHD 43-06 6/11/2019 2-(,/ ,?r WELL/PUMP PERMIT