Laserfiche WebLink
I WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT GALL (ZU9) 953-fbUf FOR INSPECTIONS tAVIKtb l YEAR FROM DATE ISSUED <br />JOB ADDRESS 10230 Trinity Parkway CITY/ZIP Stockton, CA 95219 <br />CROSS STREET Cosumnes Drive APN 06602030 PARCEL SIZE 2.23 LAND USE APPLICATION # 9100 <br />OWNER NAME SAFStor Real Estate Co., LLC PHONE <br />OWNER ADDRESS 444 Seabreeze Blvd, Suite 840 CITY/STATE/ZIP Daytona Beach, FL 32118 <br />CONTRACTOR Atlas Technical Consultants LLC PHONE 510-330-6533 <br />CONTRACTOR ADDRESS 2001 Crow Canyon Rd, Suite 200 CITY/STATE/ZIP San Ramon, CA 94583 <br />SUBCONTRACTOR West Coast Exploration Inc. PHONE 209-985-7541 <br />SUBCONTRACTOR ADDRESS PO Box 133 CITY/STATE/ZIP Escalon, CA 95320 <br />LICENSE X C-57 ❑ C-61 ❑ D-09 ❑ Other NUMBER 870761 EXPIRATION DATE 1/31/2024 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) L Arsenic (4393) <br />INTENDED USE ❑ Domestic/Private ❑ Irrigation/Agricultural ❑ Industrial ❑ Water Quality Monitoring X 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 />I Monitoring Wells) # of wells ❑ Soil Boring(s) # of borings x Geotechnical <br />❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />7 # of borings <br />L New rump ❑ rump Kepiacement ❑ rump Kepair ! Kaise weir casing <br />WELL CONSTRUCTION <br />Drilling Method ❑ Mud Rotary ❑ Air Rotary X Auger ❑ Cable Tool ❑ Push Point ❑ Other <br />Proposed Well Depth 15-40 ft Excavation _4 in diameter X Open Bottom ❑ Gravel Pack/Gravel Size <br />F Conductor Casing in diameter / Conductor Casing Depth ft <br />in diameter <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched ❑ Steel ❑ Plastic ❑ Stainless Steel X Other n/a <br />Grout Seal Depth full ft IR Neat Cement (94 Ib bag/5-10 gal water) ❑ Sand Cement sack mix/7 gal water <br />❑ Bentonite (20% solids) ❑ Other <br />Grout Placement Method X Pumped ❑ Free Fall ❑ Other ❑ Retardant / Accelerator (name) PA V MACK r__ <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 E: Submersible:] Turbine ❑ Other HP Pump Set ft Standing Water Lev 1OAQUIN couNi <br />Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the follo b s <br />Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, <br />potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, <br />Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />DEPARTMENT USE ONLY <br />Application Accepted By Date -71712 a Area .Sfc�`k�Jll Employee ID# <br />Grout Inspection By Date 7_9 ❑ SPECIAL Well Permit <br />Pump Inspection B Date ❑ WAIVER Received <br />Soil Boring Inspection Byii� 00 Date Constructed Well Depth ft <br />COMMENTS 'femle 7a bN �� :r'E; 4 eleeper zw 30 6�al or �fe4�??r �V�14���' Is pn�.�u:� ✓P� <br />PE <br />Codes <br />Sc Received Check#/ <br />Info B as <br />Amount D e Permit/ Invoice # Well ID# <br />Remitted Service Request # <br />7a <br />150 <br />140 <br />EHD643-06 04/07/2022I , I / 1/�J_ 2,v �� <br />O I / / Page I of 2 Well /Pump Permit <br />l� / 1 l <br />