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I WELL/PUMP PERMIT $1.404 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT GALL (209) 953-7697 FOR INSPECTIONS hAVIKhb 1 YEAR FROM UATE ISSUED JOB ADDRESS a SOD N v : 37.920766 °, -121.319115' CITY/zIP Stockton, CA, 95206 CROSS STREET Navy Dr/Forres al Village APN 16-333-003 PARCEL SIZE46.68 acr LAND USE APPLICATION # Unknown OWNER NAME Amanda Thomas / C I }t/ 6f S tOL k-�a N PHONE X09) 937-7540 OWNER ADDRESS 9099 Mariners Drive CITY/STATE/ZIP Stockton, CA 95219 CONTRACTOR Gregg Drilling, LLC PHONE (925) 313-5800 CONTRACTOR ADDRESS 950 Howe Road CITY/STATE/ZIP Martinez, CA 94553 SUBCONTRACTOR Kleinfelder, Inc SUBCONTRACTOR ADDRESS 2001 Arch Airport Rd, Suite 100 LICENSE E C-57 ❑ C-61 ❑ D-09 ❑ Other CITY/STATE/ZIP PHONE (209) 993-2269 Stockton, CA 95206 NUMBER 1044456 EXPIRATION DATE 09/30/2022 DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) i Arsenic (4393) INTENDED USE ❑ Domestic/Private ❑ Irrigation/Agricultural C Industrial ❑ Water Quality Monitoring E Soil Sampling/Characterization ❑ Public Water System If different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification E Other two (2) cone penetrometer test soundings ❑ Monitoring Well(s) # of wells ❑ Soil Boring(s) # of borings E Geotechnical five (5) # of bong ❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair ^t Y ❑ New PumD ❑ PumD Replacement ❑ Pumo Repair ❑ Raise Well Casino Drilling Method ■ Mud Rotary ❑ Air Rotary ■ Auger ❑ Cable Tool ❑ Push Point ❑ Other Proposed Well Depth 70 to 100 ft Excavation 2 to 8 in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size In d a e ❑ Conductor Casing in diameter / Conductor Casing Depth ft EN Oq QUlN Well Casing Diameter in Thickness/Gauge/ASTM Sched LiSteel LiPlastic LlStainless Steel LJ 61* /RO C Grout Seal Depth 70 to 100 It ■ Neat Cement (94 Ib bag/5-10 gal water) ❑ Sand Cement sack *I civ ❑ Bentonite (20% solids) ■ Other up to 5% bentonite Grout Placement Method ■ Pumped ❑ Free Fall ■ Other Tremie Full -Depth ❑ Retardant / Accelerator (name) PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other ❑ Concrete Pedestal [I Dimensions: Width ft Length ft Thick n ❑ Christy Box ❑ Stove Pipe PUMP ❑ Submersible Turbine ❑ Other HP Pump Set ft Standing Water Level ft Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the following items: GPS Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, potential sources of contamination, sewers or private disposal systems. Include distance from two property lines. For Domestic, Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. MIN'IN11 N1 24 HOUR ,kDVANCE NOTICF. IZI-,QtIRED FOR INSPECTIONS - PLEASE ('ALT. (209) 953-7697 DEPARTMENT USE ONLY Application Accepted By ��LL Date Grout Inspection By Date Pump Inspection By Date Soil Boring Inspeciion By Y4 C Date , COMMENTSDabwIri ehL/odfctim6 it oelrr'iiwf or *Jher pe1M'# .0 14' Area I 5}04�40" Employee ID# 7 SPECIAL Well Permit WAIVER Received Well Depth ft T m g v z C7 PE Codes SC Received Check#/ Info B Ca h Amount Date Permit/ Invoice # Well ID# Remitted Service Re uest # 4379 /So GHrxL43-06 04/07/2022 � n P:rge I of 2 Well /Pump Permit ��,