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Y <br />L <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />r4VI I-1<EFUNUABLE PERMIT k;ALL ZU`J Ub3-/b9/ FOR INSPECTIONS tANIKtS 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 5999 Escaallo�n Bellota Road 2 CITYIZIP Linden. CA Sv' <br />'O <br />CROSS STREET APN �/ a PARCEL $IZERLAND USE APPLICATION* <br />OWNER NAME Foster Farms / InE�k J �;�I1 f //✓is] ILL C PHONE 209-398-6716 <br />OWNER ADDRESS 14519 W. Collier Road El k /y5 / L jVi4�4 CITY/STATE/LP Delhi, CA 95315 <br />CONTRACTOR Krazan & Associates, Inc. _� PHONE 559.348.2200 <br />AODREsa 215 W. Dakota Avenue <br />rOR Krazan & Associates, Inc. <br />ADDRESS 215 W. Dakota Avenue <br />LICENSE -0 C-57 D C-61 D D-09 U Other <br />CIr /STATE/ZJP Clovis, California 93612 <br />PHONE 559.348.2200 <br />CITY/STATE/ZIP Clovis, California 93612 <br />NUMBER 499908 EXPIRATION DATE 10.31.2018 <br />DOMESTIC WELL SAMPLING: D General MineraUColiform Bacteria (4391) Dibromochloropropane (4392) ❑ Arsenic (4393) <br />WENDED USE O Domestic/Private U Irrigation/Agricultural n Industrial -j Water Quality Monitoring U Soil Sampling/Characterization <br />D Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK [I New Well 1 1 Replacement Well ❑ Well Alteration/Modification U Other <br />U Monitoring Well(s) # of wells D Soil Bodng(s) #ofbodngs Geotechnical 2 #of borings <br />n Out -Of -Service Well D Out -Of -Service Well Renewal n Cross -Connection Repair eel) <br />D New Pump n Pump Reolacement D PumD Repair ❑ Raise Well Casino <br />Drilling Method n Mud Rotary D Air Rotary V Auger D Cable Tool U Push Point U Other <br />Proposed Well Depth ft Excavation in diameter ❑ Open Bottom n Gravel Pack/Gravel Size in diameter <br />D Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter_ in Thickness/Gauge/ASTM Sched n Steel n Plastic U Stainless Steel Other <br />Grout Seal Depth ft V Neat Cement (94 lb bag/5-10 gal wafer) n Sand Cement sack mixl7 gal water <br />U Bentonite (20% solids) n Other <br />Grout Placement Method C Pumped D Free Fall n Other U Retardant / Accelerator (name) <br />PEDESTAL Installed By U Driller a Pump Contractor Ll Other <br />U Concrete Pedestal ❑Dimensions: Width ft Length ft Thick in n Christy Box a Stove Pipe <br />PUMP a Submersible Turbine Other 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 />MINULIM 48 HO D A NOTIC EQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE Managing Engineer DATE / <br />D ART ENT US O 1 - <br />Application <br />Application Accepted By Area Employee ID# j� <br />Grout lnspecti Date ell Permit <br />Pump Inspect Date WAIVER Received <br />Soil Boring Insp Date Constructed Well Depth ft <br />COMMENTS <br />65-011-jr,1026MUOULTIM "10 <br />EHD 43-06 revised 4/14118 WELL /PUMP PERMIT <br />