Laserfiche WebLink
r <br /> WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1666 EAST HAZELTON AVENUE•STOCKTON CA 95205.6232(209(468-3420 <br /> NON-REFUNDABLE PERMIT -_ yyWW.4 goY;Ofg/Dhd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS '3 70ApM11'1Q,,r 38.021040'.Loo!-121.393@76' cnvfbPtockton_CA.95206 - <br /> CROSS STREET _Mariners Dr/Hammer Ln APN0 1-130-210 PA*msm3.D LANO USE APPLICATIONS Unknown _ <br /> OWNER NAME T ler KBIIeV ..10„1'' Kelley r g Ors PHONE 209 477-1207 <br /> 'OWNER ADDRESS 9099 Mariners Drive 76a7 PtirkWWCk Dr: ciry/9- rap Stockton.CA 95219 /SJOZ144 9 S"IR 07 <br /> CONTRACTOR Gregg Drilling,LLC PHONE (925)313-5800 <br /> CONTRACTOR ADDRESS 950 Howe Road CnYBTAmmp Martinez,CA 94553 <br /> SUBCONTRACTORICONSULTANT Kleinfelder,Inc pHo,E (209)993-2269 <br /> SUBCONTRACTORICONSULTANT ADDRESS 2001 Arch Airport Rd,Suite 100 CITWSTATE/Zlp Stockton,CA 95206 <br /> LICENSE N C-57 i C-61 10-09 Other-_ NuruR 1044458 EXPIRATION DATE 09/3012022 <br /> BILLING PARTY: i t OWNER -i CONTRACTOR N SUINCONneACTOR/CON6ULTANT <br /> DOMESTIC WELL SAMPLING:I General Mineral/Coliform Bacteria(4391) i Dibromochloropropane(4392),;Arsenic(4393) <br /> l DomestiNPrivate Irrigation/Agricultural f i Industrial i Water Quality Monitoring Soil Sampling/Charaderizetion <br /> i Pudic Water System <br /> 11 der.M tom Omer. watt system Nrele UrA d Nemo or Ph—Number <br /> TYPE OF WORK .i New Wal !I Replacement Well f Well AlleratarJModillcmlion N Other three(3)cone penetrometer lest soundings <br /> Monitoring Well(s) a or wells Sod Borings) a ul bongs N Geotechnical rune(9) a W b1-40 <br /> Out-OfService Wel i OW-Of-Service Well Renewal Cross-Comeclion Repair <br /> New Pump Pump Re p!3ce emit Frump Repan Reise_Wall Castn�_.__ <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary i Air Rotary i Auger Cable Tool Push Point I Other__ <br /> Proposed Well Depth 55 to 100 R Excavation 2 to 8 In diameter Open Bottom t Gravel Pack/Gravel Slze in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth _tt <br /> Weil Casing Diameter_In Thidmess/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 55 to 100 6 0 Neat Cement(94/b Dag15-10 gel water) Send Cement sack mix!)gal water <br /> Bentonite(20%solids) N Other uD IO 5N bentonite <br /> Grout Placement Method 0 13Tm1ped i t Free Fall N Other TmmP3 Futb_rk,plh Retardant IAcceleralor In:vnCl I <br /> EDESTAL Installed By Driller Pump ConVador i Other- nWidth R <br /> Concrete Pedestal•Dimensions: dth Length - R Thidt in Christy Bos $lova Plpe <br /> P_ Submersible. Turbine ,-Other HP___ Pump Sel A Standing Water Level R i <br /> I HEREBY CERTIFY THAT 1 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 L W <br /> MI M 46 �06 DVANCE NOTICE REQUIRED FOR INS P_CTIONS-PLEASE CALL(209)953-76 i <br /> SlGrrto TttcE DATE <br /> - YMENT <br /> SEE ATTACHED BORING LOCATION MAP '`SgNJ IO8 2021 <br /> /f fN�11 /NC <br /> - - - - -11- ✓1FNOUNTy <br /> RTNjENt <br /> DEPARTMENT USE NLY <br /> Applicatio.Acceptad 9y --.J Date R a Area Employee ID/ u <br /> Grout Inspection By t/'”' Dale . I SPECIAL Well Permit <br /> Pump Inspection By _- Date I WAIVER Received i <br /> Soli Boring Inspection By Date_ Constructed Well Depth R I <br /> COMMENTS <br /> PE SC Roo iwd - Chaeta Amount Date Pem118 Invoke N War 10A <br /> Code Info Cs _ Remitted S na <br /> l Re uadly <br /> LIj7d O — -- a <br /> r <br /> t <br /> EHn A3N 0111MIC WELL IKILIP Pillion <br />