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:SS380CIV 311S 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 10 5.9C E HIGHWAY 26 CITY/ZIP STOCKTON 95215 1.29 ARMS. CROSS STREET ALPINE APN 089 i 00 6t) PARCEL SIZE -L-AND USE APPLICATION # " 1.... ii OWNER NAME ALEJANDRO BilAirsice= e Q$1> .re—lif 0°1 PHONE 408-509-5724 OWNER ADDRESS 3141 STEVENS CREEK BLVD #365 CITY/STATE/ZIP SAN JOSE, CA 95117 CONTRACTOR GOLDEN STATE IRRIGATION & PUMP SERVICE PHONE 299-943'7774 CONTRACTOR ADDRESS 4500 E FREMONT CITY/STATE/ZIP STOCKTON, CALIF 95215 SUBCONTRACTOR NIA PHONE SUBCONTRACTOR ADDRESS CITY/STATE/ZIP LICENSE E C-57 r*C-61 E D-09 0 Other NUMBER 979833 EXPIRATION DATE 12/31/2022 DOMESTIC WELL SAMPLING: C": General Mine,-al/Coliforrn Bacteria (429 i ) 3 DibioriiiDctiloropiopane (4392) LI Arsenic (4393) INTENDED USE IX Domestic/Private CI Irrigation/Agricultural 0 Industrial El Water Quality Monitoring 0 Soil Sampling/Characterization 0 Public Water System If different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification E Other L 0 Monitoring Well(s) # of wells E Soil Boring(s) # of borings LT Geotechnical # of borings r 0 Out-Of-Service Well 0 Out-Of-Service Well Renewal E Cross-Connection Repair JA Ai 2 5 ,4 12K New Pump E Pump Replacement D Pump Repair 0 Raise Well Casing S.4 hi cu WELL CONSTRUCTION ' v Jad HE4E.LN V/pV0QU E 0 /N Cru Drilling Method 0 Mud Rotary Air Rotary E Auger Cable Tool 0 Push Point II Other rf A/ 4,7p4,T.Lzi Proposed Well Depth ft Excavation in diameter E Open Bottom 0 Gravel Pack/Gravel Size in itthiOr,V, c E Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter in Thickness/Gauge/ASTM Sched 0 Steel C Plastic E Stainless Steel 0 Other Grout Seal Depth ft 0 Neat Cement (94/b bag/5-10 gal water) C Sand Cement sack mix/7 gal water 0 Bentonite (20% solids) 0 Other Grout Placement Method 0 Pumped E Free Fall 0 Other 0 Retardant / Accelerator (name) PEDESTAL Installed By 0 Driller 0 Pump Contractor 0 Other 0 Concrete Pedestal 0 Dimensions: Width ft Length ft Thick in 0 Christy Box 0 Stove Pipe PUMP Cx Submersible 0 Turbine 0 Other HP 1.5 Pump Set 130 ft Standing Water Level 54 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 wp!!. NIININII N1 211101 If 1DN . 1. \ ( I. NO I If I REQI 1121.1)1.0R INSII ( '1 IONS.- PI I \ I ( \I I (2119) 953-v-fit/- DEPARTMENT USE ONLY Application Accepted By e...-or--7.72 / 4...., Date i id Slc7 i Area LI/Ci C Employee ID# Ffil nic Grout Inspection By Date ID SPECIAL Well Permit Pump Inspection By /1 Date a I/ 1,h-> 0 WAIVER Received Soil Boring Inspection By Date Constructed Well Depth ft COMMENTS /')e vJ ,dell WP001-/dee C.eri moleici/ 7- DECP se,,wpi/1:5 PE Codes SC Info Received Bx., Check#/ C?sh Amount Remitted, Date Permit/ Service Request # Invoice # Well ID# 143Si ° 0 ) 6(--' e -e-dit- 4)S-a I II* 14004 2-6rbil El00043-06 10/25.2021 &(W /3 -7,s3aE3a 552 Well Pump Permit