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0jf )n f'J_ <br />Invoice # Well ID# <br />r WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PrR41t7 www4jgov.org/ehd <br />EXPIRES 1 YEAR FROM DATE ISSUED <br />JoB ADOREss C/T . y In , i D1.' 38,021040". Log: -121, fi, 676^ <br />J <br />CmrnP Stockton, CA, 95206 <br />CROSSSTREET Mariners DNHammer Ln APN 0 71-130-130 PARCELSIZE 1,546 LAW USE APPLICATIONS Unknown <br />OWNER NAME Tyler Kelle &D'hi'1 4e 11W O� � �fW LI-LPT <br />( - PHONE (209) 477-1207 <br />OWNER ADDRESS 9099 Mariners Drive <br />CITYISTATE/ZIP Stockton, CA 95219 <br />CONTRACTOR Gregg Drilling, LLC <br />PHONE (925) 313-5800 <br />CONTRACTOR ADDRESS 950 Howe Road <br />CITYISTATEmP Martinez, CA 94553 <br />SURCONTRACTORICONSULTANT Kleinfelder, Inc <br />PH... (209) 993-2269 <br />SUBCONTRACTOR/CONSULTANT ADDRESS 2001 Arch Airport Rd, Suite 100 <br />CITY/STATE/IJP Stockton, CA 95206 <br />LICENSE E C-57 I C-61 I D-09 I • Ogler NUMBER 1044456 EXPIRATION DATE 09/30/2022 <br />BILUNO PARTY: Ii OWNER 'I CONTRACTOR N SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLI i General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Araenic (4393) <br />INTENDED USE I , Domeslic/Private 11 Irrigation/Agricultural Industrial ; ; Water Quality Monitoring 0 Soil Sampling/Characterization <br />1 I Public Water System <br />II different I— Owner Water Sysiem Neme Contact Name or Phane Number <br />TYPE OF WORK i ; New Well 1: Replacement Well I I Well Alteration/Modification Other three (3) cone penetrometer test soundings <br />II Monitoring Well(s) # of wells I Soil Boring(s) #of borings N Geotechnical four (4) *ar boungs <br />I Out -Of -Service Well I , Out -Of -Service Well Renewal Cross -Connection Repair <br />1 ; New Pump Pump Repincement : Pump Repair Raise Well CosinO -_- —_—----___-. WELL CONSTRUCTION <br />Drilling Method Mud Rotary Air Rotary , I Auger I I Cable Tool I I Push Point t Other___ <br />Proposed Well Depth 70 to 100 ft Excavation 2 to B in diameter Open Bottom I Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth n <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched I I Steel Plastic I Stainless Steel I ; Other <br />Grout Seal Depth 70 to 100 ft ■ Neat Cement (94 lb bagl5-10 gal wafer) I Sand Cement sackmW7 gal water <br />I I Bentonite (20% solids) N Other up to 50/9 bentonite <br />Grout Placement Method 0 Pu,nped I 1 Free Fall X Other Tromie, fug-Duptlt I I Retardant / Accelerator (narne) <br />PEDESTAL Installed By 1 Driller I Pump Contractor ! I Other <br />Concrete Pedestal 'Dimensions Width R I-ength R Thir-k in Christy Box 11 Stove Pipe <br />Submersiblei, Turbine Other HP_- PumpSct__ R rinrgnp 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 1 AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />SIGNED <br />CE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />TITLE- }1f71 DATE %A /{ ZOZr% <br />DEPARTMENT USE ONLY <br />LLrZ ► sb�i.,), <br />Application Accepted By Dale Area � 8 .Z Employee 10# <br />Grout Inspection By Date z ((/}.L SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS <br />u <br />FC 08 <br />2021 <br />HD pUltv gEN� �NTV <br />RTMENr <br />PE SeReceived Check#/ Amount Date PermiU <br />Codes Into 8 as Remitted Service Re est to <br />Invoice # Well ID# <br />H09 K0 <br />EHO410e 6111=19 ( / / 53 6 / F <br />WELL IPUNP PERMIT <br />