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I WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 Idr1AI_0o ..u...,, r,__..._ ' ^'•"' I+ALL LU9) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 2005 Alpine Road CITY2IP Stockton / 95215 CROSS STREET State Highway Route 26 ApN 101-130-20 PARCEL SIZE 10.07 LAND USE APPLICATION # OWNER NAME Linden Unified School District 209 887 3894 IOWNERADDRESS 18527E. Main Street PHONE CITY/STATE/ZIP Linden, CA 95236 CONTRACTOR V & W Drilling - Contact: Karli Stroing, President PHONE 209.981.7755 CONTRACTOR ADDRESS 1133 Blackhurst Drive CITY/STATE/ZIP Galt, CA 95632 SUBCONTRACTOR Condor Earth - Contact: Ron Skaggs, CA PE #44588/GE #2295 PHONE 209.601.1430 (Cell) SUBCONTRACTOR ADDRESS 188 Frank West Circle, Suite I St k LICENSE X C-57 1 C-61 ❑ D-09 ❑ Other CITY/STATE/ZIP OC tOn, CA 95206 NUMBER 720904 EXPIRATION DATE 04/30/2022 tri ..r_LL OAMPLINU: u general Mineral/Golitorm Bacteria (4391) ❑ Dibromochloropropane (4392) ❑ Arsenic (4393) INTENDED USE ❑ Domestic/Private ❑ Irrigation/Agricultural C Industrial ❑ Water Quality Monitoring D Soil Sampling/Characterization ❑ Public Water System If different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other Check#/ Amount mit! Per Cash Remitted ate Seryice Request # Invoice # Well ID# ❑ Monitoring Well(s) # of wells ❑ Soil Boring(s) # of borings X Geotechnical 2 # of borings ❑ Out -Of -Service Well ,j Out -Of -Service Well Renewal ❑ Cross -Connection Repair pA New Pump ❑ Pump Re lacement �] Pump Repair ❑ Raise Well Casing^^ffM WELL CONSTRUCTION Drilling / Method ❑ Mud Rotary Air Rotary X Auger ❑ Cable Tool ❑ Push Point ❑ Other Proposed Well Depth 10' to 25' ft Excavation 4 1/2 in diameter ❑ Open Bottom 7 Gravel Pack/Gravel Size rt� 7 Conductor Casing in diameter / Conductor Casing Depth ft IV ll Well Casing Diameter _ in Thickness/Gauge/ASTM Sched C Steel ❑Plastic C Stainless Steel Grout Seal Depth full depth 'J J �y 0g - ft X1 Neat Cement (94 Ib bagIS-10 gal water) ❑ Sand Cement S T ❑ Bentonite (20% solids) X1 OtherTrernie Grout Placement Method F1 Pumped ❑ Free Fall C Other ❑ Retardant / Accelerator (name) PEDESTAL Installed By 1 Driller Pump Contractor 7 Other ❑ Concrete Pedestal ❑Dimensions: Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe �PuMP ❑ Submersible❑ 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) 953-7697 DEPARTMENT USE ONLY Application Accepted By ---7— L– Date a Area 1 Employee ID# !e' '! K. Grout Inspection By .l i Date ❑ SPECIAL Well Permit Pump Inspection By Date ❑ WAIVER Received Soil Boring Inspection By COMMENTS Date Constructed Well Depth IV PE Sc Received Codes Info Check#/ Amount mit! Per Cash Remitted ate Seryice Request # Invoice # Well ID# enuuv-uo iw<>i<u<t Page 1 ort Well /Pump Perntit ,tel/ 9 77/ Z. -b M m D 0 0 In In N y Ty T