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WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPAR}MENT 1868 EAST HAIELToN AVENUE - STOCKTON CA 95205 -6232 (209( 468-3420 <br />NON-REFUNDABLE PERMIT _ ynN_wsjgov.org/ehd _ _ EXPIRES 1 YEAR FROM DATE_ ISSUED <br />Joe ADORES g531 me rill1Fh.; 38.0210E Loa; -121.363676' CmrmP Stockton, CA 95206 <br />CROSS STREET Mariners Dr/Hammer Ln ApN 0 71-260-030 PARCEL &N 5.0 LAND UsE APPLICATION i_ Unknown <br />OWNER NAME Mariners Cove/Lori Gomez PHONE (2901474-1551 <br />OWNER ADORESS 8531 Mariners Drive ZI4I fhakt S t SIE A CRY/STATElhD Stockton, CA 95219 Sc n <br />CONTRA, f1W Gra Drllllnq, LLC - -_ PHONE (925) 313-5800 <br />COUnt;,r'.,OR ADD+Eas 950 Howe Road GTrrsurElLP Martinez, CA 94553 <br />SUBCONTRACTOR/CONSULTANT Kleinfelder, Inc <br />SUBCONTRACTOR/CONSULTANT ADDRESS 2001 Arch Airport Rd, Suite 100 <br />PHONE (209)993-2269 <br />CRY/STATElLP_ Stockton, CA 95206 <br />IUcENEE N C-57 • I C-61 D-09 I Other NUMeen 1044456 EXPIRATION DATE 09130/2022 <br />BILLING PARTY: I DINER 1CONTRACTOR E SUBCONTRACTOR/CONBULTANT <br />DOMESTIC WELL SAMPLING: ' • General Mineral/Coliform Bacteria (4391)1 Dibrornochloropropene (4392) , Arsenic (4393) <br />INTENDED USE I Domestic/Private i I IMgation/Agricultural , i Industrial i Water Quality Monitoring / Soil Sampling/CharaclerizeUon <br />- Pudic Water System <br />-- <br />11 dlllaram Iron ONnar. Walt Sytlem Name Conlad Nartw or, Ph- I'1Umbar <br />TYPE OF WORK New Well i ; Replacement Well I Well AlleratlONModificallon Other <br />Monitoring Well(s) At of wells Sod Boring(s) IF of bonnp ■ Geotechnical one 0) 0 or bodngs <br />Out -Of -Service Wel Oul-Of-Service Well Renewal i Cross-Connecllon Repair <br />New Pump Pump, Rg4ac )elil_ I IUrnl, Repw _ _. _ _ Raise Wel Casirtg . <br />Drilling Method I i Mud Rotary i Air Rotary - i Auger Cable Tool , Push Point , Other_ <br />Proposed Well Depth 45 A Excavation 8 in diameter Open Bottom Gravel Pack/Gravel Size in Qemeler <br />Conductor Casing in diameter / Conductor Casing Depth D <br />Well Casing Diameter _ in Thictmess/Gauge/ASTM Shced Steel , i Plastic i Stainless Steel Other _ <br />Grout Seal Depth 45 R E Neat Cement (94 rb bag/5-10 gal water) i, Sand Cement sack mixl7 gal water <br />Bentonite (20% colds) 0 Other UD t0 5% ben unite _ <br />Grout Placement Method M Pumped Free Fab p Other Tremle_FulLnn t0 : , Retardant /Accelerator (name) <br />PE OESTAL Installed By Driller , Pump Contractor` Other <br />Concrete Pedestal rDimensions: Width _ R Length R ThtrJt in Christy Box o . Stove Pipe <br />PUMP SubmeMdei Turbine 1 Other - _ HP Pump Set A Standira Water Level A <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 LAWSt <br />SIGNED <br />m <br />nn(Iitc, gylly <br />DEPARTMENT USE ONLY I1 <br />Application Accepted By _ !� L, L Date]2109')ZAron 5fi e Rw Employee IDs <br />Grout Inspection By -yh� ` - 1�' _ Date J'iSPECIAL We11 Permit <br />Pump Inspection By ` Date 1, WAIVER Reeelved <br />Soil Boring Inspection By Date Constructed Wen Depth It <br />COMMENTS <br />i35Y24kS-41 <br />