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' s � <br /> 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 /> '25501 Gf1 kC WeA Y CITY/LP Y N <br /> Joe ADDRESSTracy,CA 95377 �yyy <br /> CROSS STREET None APN 209-11-059 PARCELSIZEA42MLAND USE APPLICATION# <br /> OWNER NAME Peter Khan-Costco Wholesale PHONE (425)313-6052 <br /> OWNER ADDRESS 999 Lake Drive CITY/STATE/7JP Issaquah,WA 98027 <br /> CONTRACTOR V&W Drilling PHONE (916)371-8234 <br /> CONTRACTOR ADDRESS 1133 Balckhurst Drive CmrIsTATEIZIP Galt,CA 95632 <br /> SUBCONTRACTORICONSULTANT KlelnfelderInc. PHONE 408-840-1038 <br /> SUBCOMWACTOR/CONSULTANT ADDRESS 380 North First Street,Suite A CrrYISTATEMP San Jose,CA 95112 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 720904 ExPIRATION DATE 8/15/2022 <br /> BILLING PARTY: OWNER CONTRACTOR x SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells Soil Boring(s) #of boxings x Geotechnical 6 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION(NO WELLS ONLY GEOTECHNICAL BORINGS) <br /> Drilling Method Mud Rotary Air Rotary x Auger Cable Tool Push Point Other <br /> Proposed Well Depth 80 it Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in ThickneWGauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth2u it x Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mI 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 ft Length it Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set It Standing Water Level It <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 /> MINjA�UM H R A E NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED ��//�� Dan Dockendorf TITLE Project Manager-Kleinfelder Inc. DATE 8/17/2021 <br /> EFNT <br /> IVP <br /> 18202, <br /> ZrIf Vi S <br /> RT N7 <br /> ENT <br /> oil <br /> DEPARTMENT USE ONLY (��q <br /> Application Accepted By ate Area s_ ` I Employee ID# A C J <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring In ection By /Date Constructed Well Depth ft <br /> COMMENTS :I(eiml-Alep,2e 4-p <br /> PE Sc Received Check#/ Amount Da4 Permit/ Invoice# Well ID# <br /> Codes Info Cas Remitted Service ReQuest# <br /> 37a 50 <br /> EHD 43-06 6/11/2019 1,302,1,E66-7 <br /> 7066-7 WELL/PUMP PERMIT <br />