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r <br />NA225096 <br />1New (,eis- bt WELL/PUMP PERMIT <br />SAN JOAOUIN DUN, 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 Northwest corner of Newcastle Rd CITYIZIP Stockton, 95215 <br />CROSS STREET Arch Rd APN 179-220-39/179-22044 PARCEL SIZE 54.53 / 6.92 LAND USE APPLICATION # <br />OWNER NAME IDI Stockton Logistics III LLC PHONE <br />OWNER ADDRESS 1197 Peachtree street suite 600 CITYISTATEIZIP Atlanta, Georgia 30361 <br />CONTRACTOR Neil O. Anderson: a Terracon Company PHONE 209-367-3701 <br />CONTRACTOR ADDRESS 902 Industrial Way CITYISTATEIZIP Lodi, California 95240 <br />SUBCONTRACTOR Neil 0. Anderson: a Terracon Company PHONE 209-367-3701 <br />SUBCONTRACTOR ADDRESS 902 Industrial Way CITY/STATE/Zip Lodi, California 95240 <br />LICENSE 2t' C-57 I l C-61 I I D-09 I . Other NUMBER 669004 EXPIRATION DATE 5/31/2023 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE IDomestic/Private f' Irrigation/Agricultural I Industrial I Water Quality Monitoring lit Soil Sampling/Characterization <br />I Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK I New Well I ! Replacement Well 1 1 Well Alteration/Modification I: Other <br />I Monitoring Well(s) # of wells I I Soil Boring(s) # of borings Ix Geotechnical 35 # of borings <br />I ! Out -Of -Service Well I Out -Of -Service Well Renewal I Cross -Connection Repair pw <br />New Pum 1, Pum Replacement L, Pum Repair 1_, Raise Well Casin �'f <br />WELL CONSTRUCTION E1 <br />Drilling Method I Mud Rotary I Air Rotary Ix Auger I Cable Tool I Push Point I . Other <br />Proposed Well Depth 20-50 ft Excavation 6• in diameter I Open Bottom I Gravel Pack/Gravel Size A Ubi d#r5et¢f <br />I . Conductor Casing in diameter / Conductor Casing Depth ft jJ L <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched I Steel I Plastic I Stainless Steel I OtherAIV JCgQUI <br />Grout Seal Depth 20-50 ft Ki Neat Cement (94 Ib bag/5-10 gal water) I Sand Cement <br />I Bentonite (20% solids) I I Other �KTM <br />Grout Placement Method t! Pumped Do Free Fall I l Other I ' Retardant / Accelerator (name) <br />PEDESTAL Installed By I I Driller I! Pump Contractor I Other <br />Concrete Pedestal I Dimensions: Width ft Length ft Thick <br />�in I Christy Box I Stove Pipe <br />PUMP I . Submersible I Turbine I I Other HP Pump Set ft Standing Water Level ft <br />Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS <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 />N11:NINI1 N1 24 110UR ADVANC1, NOIICL RLQt IRED FOR INSPE(I IONS - PLEASE CALL (209) 953-7697 <br />DEPARTMENT USE ONLY t <br />Application Accepted By U L-- Date { Area ST�� Employee ID# A 6✓ <br />%,, <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection ByDate - WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth ft <br />COMMENTS P. I F beif ► GAF Pf Lf N. 3L7 O ' ' c �U rc.J ,-� Pr <br />PE Sc Received eck Amount Date PermlU Invoice # Well ID# <br />Codes Info Remitted ervice Request # <br />4S:��a - ZZ 00 35 <br />EH13043-06 04/07/2022 Page I of 2 Well / Pump Permit <br />T <br />1 <br />m <br />D <br />v <br />v <br />m <br />m <br />N <br />'z <br />VTy <br />VT <br />r <br />