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1 ' WELL/PUMP PERMIT 2192 <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 12555 S Murphy Rd. CITY/ZIP Escalon/95320 <br />CROSS STREET Dodds Rd. APN 203-130-01 PARCEL SIZE 266.66 LAND USE APPLICATION # <br />OWNER NAME C&G Ranch LLC - Contact Rob Norman PHONE 209-479-4661 <br />OWNER ADDRESS PO Box 628 CITY/STATE/ZIP Ripon/CA/95366 <br />CONTRACTOR Delta Pump Inc. PHONE 209-466-9625 <br />CONTRACTOR ADDRESS 646 S. California St. CITY/STATE/ZIP Stockton/95203 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS CITYISTATEIZIP <br />LICENSE C-57 X C-61 D-09 Other NUMBER 1055434 EXPIRATION DATE 7/31 /2023 <br />DOMESTIC WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) a Dibromochloropropane (4392) D Arsenic (4393) <br />INTENDED USE Domestic/Private Xlrngation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />If different from Owner Water System Name Contact Name or Phone Number <br />TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br />Monitoring Well(s) # of wells Soil Boring(s) 4 o borings Geotechnical <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair CA�7/� / <br />New Pump Pump Replacement XPump Repair Raise Well Casing <br />WELL CONSTRUCTION 19 <br />Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point Other SAN <br />Proposed Well Depth ft Excavation in diameter Open Bottom Gravel Pack/Grddiameter <br />Conductor Casing in diameter / Conductor Casing Depth ft N CEp EN 7'A TY <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel 71 Other ARrMEA_— <br />Grout Seal Depth ft ❑ Neat Cement (94 Ih bag/5-10 gal water) Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) ; Other <br />Grout Placement Method Pumped Free Fall Other Retardant I Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions. Width ft Length ft Thick <br />in Christy Box Stove Pipe <br />PUMP Submersible Turbine Other HP _Z5— Pump Set 140 ft Standing Water Level _ ft <br />I'lot Plan Reyuirenicnts: Attach :r plot plan with the exact location of water well with respect to the following, items: GPS <br />Coordinates, property lines, ad.joinill- properties, ",eater bodies or courses, drainage pattern. roads, esistin- wells, structures, <br />potential sources of coutainillation, SeNNers or pri',,ate disposal systems. Include distance from two property lines. For Domestic, <br />A-riculture, Industrial well, proN ide location of any water wells nr surface dater within 2110' ra(lius of proposed well. <br />1TIN11*111 Nt 24 Ifo! <br />D E P A R T M E N T U S E O N L Y <br />Application Accepted ByDate s-:/)7/70- Area qjq9 Employee ID# A6 <br />Grout Inspection ByDate :1 SPECIAL Well Permit <br />Pump Inspection By Date 2� '�Vs�}�� ZJ� 2 WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS v C f Y�A ► c4 eS i <br />u =�-5 vo N _ CA 4 N C -N- . IF "11q <br />Ivi <br />m <br />D <br />v <br />v <br />m <br />m <br />N <br />N <br />PE SC Received <br />Codes Info <br />Chec <br />Amount Date Permit/ <br />Remitted Service Re uest # <br />Invoice # Well ID# <br />439-1.0570 <br />\M2'MZM <br />i <br />LHIk1.0 o6 10 25 2u2I t'a,c 1"1 2 %%,Il Nuwp P�nnii <br />