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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1968 EAST HAZELTON AVENUE-STOCKfON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.or /ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 3201 E.Morada LaneCITY/ZIP Stockton 95212 w <br /> m <br /> CROSS STREET Holman Road APN 124-300-11 PARCEL SIZE 13 acres LAND USE APPLICATION# <br /> OWNER NAME College for Certain II,LLC PHONE H <br /> OWNER ADDRESS 100122nd Avenue,Suite 100 CITY/STATE/ZIP Oakland,CA 94607 0 <br /> CONTRACTOR Rockridge Geotechnical,Inc.attn Devin LandkamerPHONE 970-215-7740 D <br /> CONTRACTOR ADDRESS 270 Grand Avenue CITY/STATFJZIP Oakland,California 94610 D <br /> m <br /> SUECONTRACTOR/CONSULTANi Middle Earth GeoTesting,Inc. PHONE 714 633-5025 m <br /> SUBCONTRACTORICONSULTANT ADDRESS 954 Lemon Street Cm/STATE/ZIP Orange,California 92867 <br /> LICENSE VC-67 U C-61 'J D-09 L.Other NUMBER 899451 EXPIRATION DATE 613012023 <br /> BILLING PARTY: L OWNER Y CONTRACTOR LJ SUSCONT CTOR/CONSULTANT <br /> [DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391)U Dil�romochloropropane(4392)1.,Arsenic(4393) <br /> INTENDED USE Domestic/Private C Irrigation/Agricultural D Industrial D Water Quality Monitoring Soil 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 G Replacement Well r Well Alteration/Moditl tion ❑Other <br /> 0 Monitoring Wells) #Of wells C_Soil Boring(s) d or borings Geotechnical 4 u of borings <br /> J Out-Of-Service Well lJ Out-Of-Service Well Renewal r1 Cross-Connection Repair <br /> New Pump -Pump Replacement D Pump Repair C Raise Well Casing <br /> WELL CONSTRUCTION <br /> !Drilling Method _'Mud Rotary d Air Rotary C Auger L?Cable Tool 7 Push Point Other Cone Penetration Tests <br /> — /;� <br /> Proposed Well Depth 50-100 ft Excavation 1.7 in diameter a Open Bottom Li Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft f V <br /> NIA Well Casing Diameter_in Thickness/Gauge/ASTM Sched U Steel i,Plastic I;Stainless Steel 1 Other \ <br /> Grout Seal Depth 50-100 ft Neat Cement(94 lb bag/5-10 gal water) L Sand Cement sack mix/7 gal water <br /> Bentonite(20%solid ' U Other <br /> Grout Placement Method U Pumped . 'Free Fall Vt'Olher tremie if applicable _I Retardant/Accelerator(name) <br /> PEDESTAL WA Installed By Driller r, Pump Contractor Other <br /> Concrete Pedestal❑Dimensions:Width ft Length ft Thick in ❑Christy Box D Stove Pipe <br /> Pump N/A Submersibleu Turbine U Other HP Pump Set It Standing Water Level ft <br /> 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 COM ENSATION LAWS. <br /> MINIMIJI UR / E NOTICE REQUIRED FOR fjq PECTI NS-PLEASE CALL(209)953-71697 j <br /> SIGNED TRLE t �n� DATE Z J <br /> i <br /> TPT <br /> I <br /> r <br /> O <br /> q R N <br /> I p r N y <br /> l l l l l l l l l l l l i l I_L.LI 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 <br /> DEPARTMENT USE ONLY <br /> ApplicationAcceptedBy �GL Date OJ ?1 Area�,St,)J1'/' EmployeelD# <br /> Grout Inspection By Date ill I E SPECIAL Well Permit <br /> Pump Inspection By Date 1 I WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B ash Remitted Service Re uest# <br /> 7 D Ivor)q <br /> EHO 43.O6 8/11/2019 / WELL(PUMP PERMIT <br />