Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
I WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />IVUIV-KEFUNDABLE PERMIT UALL <br />JOB ADDRESS 1181 N Zuckerman Road <br />(CROSS STREET Zuckerman Rd <br />(OWNER NAME PG&E <br />Ub3-/1by/ FOR INSPECTIONS tAf IKtb 7 YEAR FROM DATE ISSUED <br />2TY/ZIP Stockton, CA 95206 <br />APN 129-31-012 PARCEL SIZE 13.51 LAND USE APPLICATION # <br />(OWNER ADDRESS 6121 Bollinger Canyon Road <br />Kleinfelder <br />PHONE <br />CITY/STATE/ZIP San Ramon, CA 94583 <br />PHONE <br />CONTRACTOR ADDRESS 2001 Arch Airport Rd, Suite 100 CRY/STATE/ZIP Stockton, CA 95206 <br />SUBCONTRACTOR ConeTec,Inc. PHONE 510-357-3677 <br />SUBCONTRACTOR ADDRESS 820 Aladdin Ave <br />LICENSE C-57 I C-61 D-09 1 Other. <br />NUMBER <br />CITY/STATE/ZIP San Leandro, CA 94577 <br />1049248 EXPIRATION DATE 1/31/2023 <br />DOMESTIC WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) ❑ Dibromochloropropane (4392) 0 Arsenic (4393) <br />INTENDED USE fl Domestic/Private ❑ Irrigation/Agricultural -1 Industrial ❑ Water Quality Monitoring ' Soil Sampling/Characterization <br />11 Public Water System <br />If different from Owner Water System Name Contact Name or Phone Number <br />TYPE OF WORK G New Well ❑ Replacement Well 17 Well Alteration/Modification ❑ Other <br />Monitoring Well(s) # of wells Soil Boring(s) # of borings /Geotechnical 2 # of bcrin <br />Out -Of -Service Well Out -Of -Service Well Renewal ❑ Cross -Connection Repair RE <br />=i New Pump ❑ Pumo Replacement J PumD Reoair ❑ Raise Well Casino <br />Drilling Method 'U Mud Rotary ❑ Air Rotary Auger ❑ Cable Tool C Push Point ii' Other CPT FEB -24 <br />Proposed Well Depth 150 ft Excavation 2 in diameter ❑ Open Bottom Fl Gravel Pack/Gravel Size SA 61 C,in diamete <br />Conductor Casing in diameter / Conductor Casing Depth ft /���tvVJgQU/NC <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched U Steel _. Plastic I Stainless Steel , Otne-11L RCNM <br />Grout Seal Depth 150 It Neat Cement (941b bagi5-10 gal water) ix// <br />Sand Cement sack m7 gal 4di6T <br />Bentonite (20% solids) Other <br />Grout Placement Method i I Pumped 2"'Free Fall X Other tremie ❑ Retardant / Accelerator (name) <br />PEDESTAL Installed By CI Driller Pump Contractor ❑ Other <br />❑ Concrete Pedestal _Dimensions: Width ft Length ft Thick <br />n Christy Box I Stove Pipe <br />PUMP _ Submersible Turbine I Other HP Pump Set ft Standing Water Level ft <br />Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS <br />Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, <br />potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, <br />Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. <br />MINUMUNt 24 [[Of ;, 1DVANC F. NOTICE REQLIRI,,D FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />DEPARTMENT USE ONLY <br />Application Accepted Byoe Date <br />Grout Inspection By Date 6 ?/2— <br />Pump Inspection By Date <br />Soil Boring Inspection By Date <br />AMENTS I — I A90' _ C F -r i}l 7evL71o.c/ "-RIEV . 3 z <br />Area S Employee ID# <br />❑ SPECIAL Well Permit <br />❑ WAIVER Received <br />Constructed Well Depth <br />ft <br />W <br />FD <br />IL . <br />5NT <br />ff-'\j <br />PE <br />Codes <br />SC Received Check#/ Amount Date Permit/ Invoice # Well ID# <br />Info Cash Remitted Service Request # <br />2-29-27- 22 <br />17I1D043.06 10!252021 Porte 1 ort <br />Well , Pump Permit <br />