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r r - <br />1 WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS 100J!% Navy Drive ciTymp Stockton 95206 <br />CROSS STREET Argonaut St. APN 163-23-047 PARCEL SIZE 5.1 S AGND USE APPLICATION # <br />OWNER NAME USA Waste of CA, Inc. Mr. Sam Jager _ PHONE 530-356-3756, <br />OWNER ADDRESS 11931 Foundation PI, Ste 200 CITYISTATEIZIP Gold River CA 95670-4540 <br />CONTRACTOR Salem Engineerin-gGrouR, Inc. PHONE 559 207-916'8- <br />CONTRACTOR <br />07-976$CONTRACTOR ADDRESS 472 _yFjac!QUel�n - CIYISTATEIZIP_ Fresno. CA 93Z22 <br />SUBCONTRACTOR PHONE <br />SUBCONTRACTOR ADDRESS CITYISTATEILP <br />LICENSE IXG57 O C-61 0 D-09 D Other NUMBER 970772 ExINRAmN DATE 3-31-22 <br />DOMESTIC WELL SAMPLING: D General Mineral/Cokform Bacteria (4391) ❑ Dibromochloropropane (4392) ❑ Arsenic (4393) , <br />INTENDED USE 11 Domestic/Private 0 Inigation/Agricultural -2 Industrial _ Water Quality Monitoring EWI Sampling/Characterization <br />0 Public Water System <br />If different from Owner Water System Name Contact Name or Phone Number <br />TYPE OF WORK 0 New Well C Replacement Well a Well Alteration/Modification CI Other <br />0 Monitoring Wells) # of wells CI Sail Borings) xof bodnps EXGeotechnkmi 4 oIb6"0: <br />D Out -Of -Service Weil 0 Out -0f -Service Well Renewal : Cmas-ConneGbn Repair 15 to 50 fel <br />0 New Pump 0 Pump Replacement n Pump Reoair Raise Well Casing <br />U1 <br />m <br />D <br />O <br />v <br />A <br />a <br />Ez <br />FT <br />PE Sc Received Checkltl Amount <br />Codes Info Cash Remitted Date <br />Drilling Method ❑ Mud Rotary 0 Air Rotary XAuger 0 Cable Tool i, Push Point Other <br />`>'37uZ sr3 2 <br />, <br />Proposed Well DepHS7; S-0 It Excavation in diameter - Open Bottom r Gravel Pack/Gravel Size in diameter <br />C Conductor Casing in diameter I Conductor Casing Depth ft <br />Well Casing Diameter in Thickness/Gauge/ASTM Schad Steel Li Plastic 0 Stainless Steel Other <br />rJ to fl <br />Total l)se Depth ft "eat Cement (94 111 bag/5-10 gal water) a Sand Cement sack mWd7 gal water <br />❑ Bentonite (20% solids) C Other <br />rout Placement Method C Pumped 0 Free Fall EXOther= Tremmie Retardant I Accelerator (name) <br />EDESTAL Installed By '`, Driller '.1 Pump Contractor [I Other <br />Concrete Pedestal L:Dlmenslons Width It Length it Thick <br />in Christy Bax Stove Pipe — - - <br />P Submso161e Turbine Other HP Pump Set R Stwwl Wabr Level R <br />Plot Plan Requirement: Attach a plot pian with the exact location of water well with respect to the Mowing hems: GPS <br />Coordinates, property tines, adjoining properties, water bodies or courses, dralnage pattern, reads, existing wells, structures, <br />potratW sources of contaminstion, sewers or private disposal systems. Include distance from two property lines. For Domestic, <br />Agriculture, ludustrld wed, provide location Of any water wills or surface water within ZOO' radius of proposed weLL <br />e�� <br />//q <br />MINIMUM 24 }LOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209) 953-7697 /"' <br />1 IYAFC <br />DEPARTMENT USE ONLY <br />- <br />/�NT <br />�® <br />Application Acoq)Wd By s� !� Dila J �� A� < r1Jr �� ^ Employee ID# c <br />c� 1 <br />Grout Inspection By �--- Dais < <- 7 0 SPECIAL Wall Pum�q N <br />J <br />Pump Inspection By Dab 0 WAMM ReCelved 0.4 QUSN <br />NFEN <br />Soil Boling Inspection By Date Construcled well Depth A�- t R��� <br />Cc)UN <br />AqtT V <br />COMMENTS <br />r4N7 <br />PE Sc Received Checkltl Amount <br />Codes Info Cash Remitted Date <br />Permw <br />Servi a Re • Invoice # Wel ID# <br />`>'37uZ sr3 2 <br />, <br />enu041-C-6 Ia:s _ua Pap< I :J _ <br />�e� -# 13 Y6 7`SSz�t <br />R'e0 furry, I,— <br />