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f-r,�/= Z� x^;�..1 S� (9-3-1G ✓.rig^ <br /> WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENMRONMEWAL HEALTH DEPAMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 (209)668.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 963.7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDREaa 32932 S MacArthur Rd CnT/LP TDracy fA 95377 g <br /> CROSS STREET W.Llnne Rd. APN 253-150-68'Ob PARCEL SaEbLLAND USE APPLICATONR <br /> OMER NAME Robert Chander PHONE 510-396-7579 K <br /> OMER ADDRESS 32932 S.MacArthur Rd. CRY/STATE17,Tracy,CA 95377 <br /> CONTRACTOR PHONE <br /> CONTRACTOR ADDRESS CRYISTATEIMP <br /> SUBCONMACTOR Martell Water Systems,Inc. /42�-/2W 925- Z�- 095E PNONE 9254324282 <br /> SuecoxlRAnoR AOpRE58 1818 Loveridge Rd. CmSTATE_ILP Pittsburg,CA 94585 <br /> LICENSE VC-57 VC-61 7 D-09 -Other 0-21 NUMUR 510952 E%PIRAVONDATE 5/31/17 <br /> GEOORAPACALINFORMATON: COorDlnaNdX Y Township_ Range_ Section_ <br /> INTENDEOUSE DOmestlQPnvate -InigaBon/Ag11wIMel -Industrial -Water Quality Monitoring -Soil Sampling/Characlefliatlon <br /> PaintmutrS System <br /> .m m. .d N.—R. m <br /> TYPEOF WORx VNryvWeII -Replacement Well -WON Allerago uModigcagon -Other <br /> -Monitoring Well(s) #of wells - Soil Boring(s) a wn,s - Geolechnical eMunno,e <br /> -Out-Ol-Service Well - 0.1-01-Service Well Removal -Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELLCONSTRUCTON <br /> Drilling Method VMud Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth 700' g Excavagan in diameter Open Bottom Grovel PaWGrav¢I -"a <br /> Conductor Casingin diameter / Conductor Casing Depth 1 _ <br /> Well Casing Diameter 5=in ThicknessfGaugWASTM Schell Certa-loc - Steel .� el Stainkrus Sleel -Other - <br /> GroutSeal Depth-Mt: �R Neat Cement(94)a bag/S/0 gal waled1 Sand Cement 10.3 sack mislr gal vader <br /> ./Bentonite(20%solids) - Other grout seal pending on E- g and lithology mdln�g <br /> Grout Placement Method I/Pumped - Free Fell -Other - ete for(mine) <br /> PEDESTAL Installed By - Driller -Pump Contract" Other <br /> _Concrete Pedestal .Dimensions:Width ft Length h Th Stove Pipe <br /> PUMP Submersible-Turbine - Other HP UIQI Pump Set UKN R Standing Water Level UKN R <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALI;�N�E <br /> IA CO RACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSA NLAWS. <br /> MI 4 OUR A�Dyf{/N 'R OU D FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED- � ! rine COO DATE 612/16 <br /> I w. T— <br /> T APM41f ) ' <br /> AfA.,1P.t0 ) <br /> N 4 ,, ) <br /> � It.:Do, <br /> i <br /> f I�ryI <br /> P'Pe'°+^4u Iwn aa6r •E.es I � <br /> 0AJt �MENTI U E LY ��/ �/Application Accepted I¢ Area Employee ID#Grout Inspectionl¢ I" SPECIAL Well Permit <br /> Pump Inspection By Dela F WAIVER Received <br /> Soil Boring Inspection By Date�1 Constructed Wall Depth It <br /> COMMENTS rOAGdGi1 S,QBEL <br /> PE SC Received Check#/ Amount Data penN1/ Invoice Well ID# <br /> Codes Info By, Dean Remitted Service R uustIf <br /> SKta7 g <br /> END 4}06 0����/ WELLIPIIMPPERMIT <br />