Laserfiche WebLink
WELL/PUMP PERMIT 0/6 <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 2382 WATERLOO RD CITY/ZIP Stockton / 95207 <br />N F ST APN 141-181-01 PARCEL SIZE857 acres <br />CROSS STREET LAND USE APPLICATION # <br />OWNER NAME PG&E PHONE 209-942-1421 <br />OWNER ADDRESS 4040 West Ln CITY/STATE/ZIP Stockton CA 95204 <br />CONTRACTOR PG&E PHONE <br />CONTRACTOR ADDRESS 535 S Center St CITY/STATE/ZIP Stockton / CA / 95203 <br />SUBCONTRACTOR PHONE <br />SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br />LICENSE ■ C-57 C-61 D-09 Other NUMBER 339629 EXPIRATION DATE 3/31/201 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />NTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />If different Irom Owner . ater System Name Contact Name or Phone Number <br />ryPF r)F wnRK E Nlo1w %/foil RonlarPmPnt WPII Wall Altaratinn/Mr0ifiratinn in nIhar Anode Well <br />Monitoring Well(s) # of wells <br />Out -Of -Service Well <br />New Pump Pump ReDlacemeni <br />Soil Boring(s) # of borings Geotechnical <br />Out -Of -Service Well Renewal Cross -Connection Repair <br />Pump ReDair Raise Well Casina <br /># of borings <br />Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br />Proposed Well Depth 200 ft Excavation 8° in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter i Conductor Casing Depth ft <br />Well Casing Diameter 2 in ThicknessiGauge/ASTM Sched Steel ■ Plastic Stainless Steel Other <br />Grout Seal Depth 100 ft Neat Cement (94 lb bag/5-10 gal water) ■ Sand Cement 10.3 sack mix/7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method ■ Pumped Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width It Length ft Thick in Christy Box Stove Pipe <br />PUMP Submersible Turbine ■ Other N A HP Pump Set ft Standing Water Level 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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE Associate Distribution Engineer DATE <br />U) <br />a <br />M <br />D <br />0 <br />v <br />m <br />m <br />y <br />Area Employee ID# d6AA7 <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />PE <br />Codes <br />EP R T M E N T U E O LY <br />Application Accepted By <br />Date <br />Grout Inspection By <br />Date <br />Pump Inspection By <br />Date <br />Soil Boring Inspection By <br />Date <br />COMMENTS <br />If, e— <br />Area Employee ID# d6AA7 <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By <br />Check#/ <br />Cash <br />Amount <br />Remitted <br />Date <br />Permit/ <br />Service Request # <br />Invoice# WellID# <br />ql <br />d <br />If, e— <br />FERWIT <br />EHD 43-06 WELL /PUMP PERMIT <br />430.12 <br />