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p1✓, <br />WELL/PUMP PERMIT <br />t. <br />N SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NnN-REFIimn AR1 F PERMIT C01 1 /2(191 953.7697 FOR IWSPFr:T1nNs FXPIRFS 1 YFAR FRnM DATE ISSt1Fn <br />JOB ADDRESS 3028 Navy Dr C"/ZIP Stockton/ 95203 <br />CROSS STREET W. Washin ton St. APN 14502018 PARCEL SIZE95.5 LAND USE APPLICATION# <br />OWNER NAME Pacific Ethanol r -, PHONE (209) 235-0370 <br />OWNERADDRESS 3028 Navy Drive CIT9/STATE/ZIP Stockton/ CA/ 95203 <br />CONTRACTOR Kleinfelder PHONE (209) 948-1345 <br />CONTRACTOR ADDRESS 2001 Arch Airport Rd, Suite 100 CITY/STATE/ZIP Stockton/ CA/ 95206 <br />SUBCONTRACTOR Middle Earth Geo Testing Inc PHONE (714) 633-5025 <br />SUBCONTRACTOR ADDRESS 954 N. Lemon St. Cmr/STATE/ZIP Orange/ CA/ 92867 <br />LICENSE XC -57 C-61 D-09 -1 Other NUMBER 899451 EXPIRATION DATE 06/30/2019 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) - Arsenic (4393) <br />INTENDED USE -1 Domestic/Private -1 Irrigation/Agricultural r] Industrial -1 Water Quality Monitoring -1 Soil Sam piing/Characterization <br />-1 Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK 7 New Well -1 Replacement Well ❑ Well Alteration/Modification ❑ Other <br />-1 Monitoring Well(s) # of wells D Soil Boring(s) #ofborings Geotechnical 8 #of borings <br />-1 Out -Of -Service Well ❑ Out -Of -Service Well Renewal -1 Cross -Connection Repair <br />-1 New Pump ❑ Pump Replacement D Pump Repair -1 Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method 7 Mud Rotary ❑ Air Rotary -1 Auger 7 Cable Tool XPush Point 1 Other <br />Proposed Well Depth 80-100 ft Excavation 2 in diameter Open Bottom -1 Gravel Pack/Gravel Size in diameter <br />LI Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Schad Steel D Plastic J Stainless Steel J Other <br />Grout Seal Depth ft X Neat Cement (94 Ib bag15-10 gal water) -1 Sand Cement sack mix/7 gal water <br />- Bentonite (20% solids) -1 Other <br />Grout Placement Method Pumped Free Fall Other Tremle Retardant / Accelerator (name) <br />PEDESTAL Installed By -I Driller -1 Pump Contractor Other <br />❑ Concrete Pedestal ;Dimensions: Width ft Length ft Thick in I Christy Box D Stove Plpe <br />PUMP rl Submersiblerl Turbine -1 Other HP Pump Set it Standing Water Level it <br />N <br />m <br />D <br />m <br />N <br />8 2018 <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITh{ /Z YON U"' <br />C <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICEN y D NMFNT�N7), <br />WORKERS ANDCOMACTIVE <br />WITH <br />LAWSE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL FPgR)ifife <br />Vr <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED LOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED <br />_ iy_ Staff Geologist I DATE 2/21/2018 <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />Date <br />Date <br />Date <br />J SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth <br />ft <br />Service Req t # <br />13.11-71111 <br />EHD 43-06 8/01116 <br />L6$)6f , tr O /IgG2 D / <br />WELL /PUMP PERMIT <br />i.TH <br />