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I WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 2979 Auto Center Circle p� CITYrZIP Stockton 95212 CROSS STREET Holman Road APN 128-020418 PARCEL SIZE 4'5 ac LAND USE APPLICATION # OWNER NAME Stockton Car Stop, LLC- attn Joey Gonzalez PHONE 916-517-8522 OWNER ADDRESS 2979 Auto Center Circle CITY/STATE/ZJP Stockton, Calitomia 95212 CONTRACTOR Rockridge Geotechnical, Inc. attn Devin Landkamer PHONE 970-215-7740 CONTRACTOR ADDRESS 270 Grand Avenue CITY/STATEILP Oakland, California 94610 SUBCONTRACTOR Exploration Geo Services Inc. PHONE 408-483-9026 SUBCONTRACTOR ADDRESS 563 Asbury St, CITY/STATEIZIP San Jose, CA 95110 LICENSE VC -57 ❑ C-61 ❑ D-09 o Other NUMBER 484288 EXPIRATION DATE 12/31/2023 DoMEsnc WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) ❑ Dibromochloropropane (4392) ❑ Arsenic (4393) INTENDED USE ❑ Domestic/Private 0 Irrigation/Agricultural 0 Industrial ❑ Water Quality Monitoring VSoil Sam pling/Characterization 0 Public Water System tf dlffererd from Owner. Water System Name Cordact Name or Phone Number TYPE OF WORK ❑ New Well D Replacement Well 0 Well Afteration/Moditication ❑ Other 0 Monitoring Well(s) # of wells 0 Soil Boring(s) # of bortnga mAeotechnical 3c ❑ Out -Of -Service Well 0 Out -Of -Service Well Renewal 0 Cross -Connection Repair C�V n ❑ New Pump 0 Pump Replacement 0 Pump Repair 0 Raise Well Casing�CJ WELL CONSTRUCTION Drilling Method D Mud Rotary 0 Air Rotary VAuger ❑ Cable Tool ❑ Push Point 0 Other Sq N 7 ?022 Proposed Well Depth 25 ft Excavation i3 in diameter ❑Open Bottom ❑Gravel Pack/Grav L VT�wu//dire diam�ter 0 Conductor Casing in diameter / Conductor Casing Depth ft N D&p EI/Tq T Well Casing Diameter _ In Thickness/Gauge/ASTM Sched ❑ Steel 0 Plastic 0 Stainless Steel 0 Other ARTMPA, Grout Seal Depth 25 ft VNeat Cement (94 /b bag/ -5-10 gal water) 0 Sand Cement sack mrxl7�gal er 0 Bentonite (20% solids) 0 Other Grout Placement Method ❑ Pumped dFree Fall dOther tremie if applicable 0 Retardant f Accelerator (name) PEDESTAL Installed By 0 Driller 0 Pump Contractor ❑ Other ❑ Concrete Pedestal ❑Dlmenslons: Width It Length It Thick lin 0 Christy Box ❑ Stove Pipe PUMP D SubmersibleO Turbine ❑ Other HP Pump Set ft Standing Water Level ft Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209)'153-76''97 DEPARTMENT USE ONLY 17 Application Accepted By� Date w? `/ '� "� Area / 1 Employee ID# Grout Inspection By Date ❑ SPECIAL Well Permit Pump Inspection By N Date ❑ WAIVER Received Soil Boring Inspection By Date 16 Zi Constructed Well Depth ft COMMENTS t'' r r' n J r C )^ (.� -f ; l'tie y g EFD043-06 10/2512021 Page I of 2 Well / Purm Pm= -%v. " --; 38 // `fg% M� EFD043-06 10/2512021 Page I of 2 Well / Purm Pm= -%v. " --; 38 // `fg%