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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY EHviRONMENTAL 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 /> JOB ADDRESS 8000 N Podesta Ln cm./LP Linden CA 95236 ' <br /> CROSS STREET Hwy 26 091-350-270 g _6"A <br /> APN PARCEL SIZE LAN*USE APPLICATION* 0 <br /> OWNER NAME Fred Ill & Beth Podesta PHONE Z(7� 601tq 137 G; <br /> OWNER ADDRESS 8000 N Podesta Ln CITY/STATE/LPLinden, Ca 95236 <br /> CONTRACTOR Purviance Drillers, INC PHONE209-887-3554 <br /> CONTRACTOR ADDRESS P-0- BOX 64 Cr7Y/STATEMpL i nd en CA 95236 <br /> SUBCONTRACTOR/CONSULTANT PHONE <br /> SUBCONTRACTOR/CONSULTANT ADDRESS CITY/STATE/7JP <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 377923 EXPIRATION DATE 7/31/21 <br /> BILLING PARTY: "_:OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:f General MineraVColiform Bacteria(4391) Dibromochloropropane(4392)I:;Arsenic(4393) <br /> INTENDED USE of DomesticlPrivate .Irrigation/Agricultural [:Industrial Water Quality Monitoring Soil Sampling/Charactenzation <br /> Public Water System <br /> K differo t hem Owner" Wstw Syetsm Nams Cmtact Name a Ph—Number <br /> TYPE OF WORK ]New Well )L Replacement Well D Well Alteration/Modification :Other <br /> 7 Monitoring Wells) #of wells O Soil Bodng(s) a of boring' Geotechnical a or bongs <br /> J Out-Of-Service Well D Out-Of-Service Well Renewal Cross-Connection Repair <br /> D New Pump Pump Replacement D Pump Repair Raise Wen Casing <br /> WELL CONSTRUCTION <br /> Drilling Method jk Mud Rotary Air Rotary . Auger _Cable Tool Push Point Other <br /> Proposed Well Depth 325" ft Excavation&_in diameter X Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing 4�k:—in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_4� in Thickness/Gauge/ASTM Sched .(o7S X Steel [;Plastic -,Stainless Steel I Other <br /> Grout Seal Depth 2pO it 7 Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mixt7 gal water <br /> Bentonite(20%solids) 7 Other <br /> Grout Placement Method )0 Pumped _ Free Fall C Other Retardant/Accelerator(name) <br /> PEDESTALInstalled By X)Duller _: Pump Contractor L Other <br /> Concrete Pedestal_Dimensions:Width Jra"*A/4-ength ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible .Turbine Other HP Pump Set ft Standing Water Level it <br /> 1 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. 1 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 /> � <br /> J< i'dCT:C c Sim iUiFt isiuSi-PLIA.SE CALL(10 - <br /> SIGNED "2'leeGtGfs LCzf�tt TITLE Cororate Secretary DATE 6/18/21 <br /> i T77. 77-1 <br /> t S <br /> e <br /> J' <br /> jiN 118 gr <br /> N <br /> HEALTHDE?A,RTfAF O-E�P�ARTMENT USE ONLY / Q <br /> Application Accepted By Date $ z�Zr Area Employee ID# <br /> Griot Inspection By t Date Vj2p I -I SPECIAL WBII Permit <br /> Pump Inspection By Date 7 WAIVER Received <br /> SoB Boring In coon By Date Constructed Well Depth ft <br /> COMMENTS - X <br /> Q � ) <br /> I r <br /> PE Sc Received 'Check* Amount PermitMInvolce * <br /> Codes Info Kash Remitted DateService Re EHD43-0e dl1111079 /�(}nl�f (?L�j� r C�/(�1 "� ERMIT <br />