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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> M N <br /> JOBADDRESS ';7y1 /rfQT1�r'� 38021040° Log:-121.363676° Crry/ztPStockton CA.95206 m <br /> n <br /> CROSS STREET Mariners Dr/Hammer Ln APN 071-260-140 PARCEL SIZE 11.0 LAND USE APPLICATION Unknown o <br /> OWNER NAME Tom McKean (Representative)gRG Al n�Ipcl},e(t-Q)G>� �•plo E(2091.957-5707 w <br /> OWNER ADDRESS 8035 Mariners Drive ry 116 � A-t 0 p CITYISTATEIZIP Stockton CA 95219 r%i4sp,at <br /> CONTRACTOR Gregg Drilling,LLC PHONE (925)313-5800 <br /> CONTRACTOR ADDRESS 950 Howe Road CITYISTATEmP Martinez,CA 94553 <br /> SUBCONTRACTORICONSULTANT Kleinfelder,Inc PHONE (209)993-2269 <br /> SUBCONTRACTORICONSULTANT ADDRESS 2001 Arch Airport Rd,Suite 100 CITYISTATEIZIP Stockton,CA 95206 <br /> LICENSE E C-57 C-61 D-09 Other NUMBER 1044456 EXPIRATION DATE 09/30/2022 <br /> BILLING PARTY: OWNER CONTRACTOR 0 SUBCONTRACTORICONSULTANT <br /> DoMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> F <br /> ENDED USE Domestic/Private Imgabon/Agricullural Industrial water Oualdy Monitoring 0 Soil Sampling/Characterization <br /> Public Water System <br /> X d'11ere111 firm owner Water System Name Crntad Name of Phrne Nurnl,,, <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells Soil Bonng(s) a°t uO1�gs 0 Geotechnical one(1) a c oonngs <br /> Out-Of-Service Well Cul-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth 45 R Excavation 6 in diameter Open Bottom Gravel Pack/Grovel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth R <br /> Well Casing Diameter_in Thick ness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 45 If 0 Neat Cement(94 Ib bag/5-10 gal wafer) Sand Cement sack miyn gal water <br /> Bentonite(20%solids) S Other up to 5%bentonite <br /> Grout Pinceiment Method E Pumped Free Fall N Other Tre mie Full-Depth Retardant/Accelerator(name) <br /> PEDESTAL Installed By Onher Pump Contractor Other <br /> Concrete Pedestal Dimensions Wdth it Length It Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Sel fl 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 15 <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MI M8 UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE operations Manager DATE 11/30/2021 <br /> REyME <br /> D CFjV A(71 <br /> F <br /> C08 O,1 Q �0�1 <br /> SEE ATTACHED BORING LOCATION MAP yEgCT'/no y CO, <br /> oFp"FNrvNTy <br /> Al <br /> - EtirT <br /> LLL <br /> DEPARTMENT USE ONLY <br /> 1 <br /> Application Accepted By C as Dale /Ooll Area 3 s Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth tt <br /> COMMENTS <br /> PE sC Received Cheek#/ Amount D e Permill InvoWellID# <br /> Codes Info Caa Remitted iced Service Re ue # <br /> 4a7a o s <br /> EHU 4.I-T uttr;C,S • �/���/}/)�� WELL!PUMP PERMIT <br />