Laserfiche WebLink
JOB ADDRESS <br /> 33•71 odd/ <br />CROSS STREET <br />OWNER NAME Marissa Garcia <br />. 37.920766°, -121.3191150 crryizip Stockton, CA, 95206 <br />PHONE (209) 688-6840 <br />Odell Ave/Downing Ave APN 17-510-011 PARCEL SIZE 1 .33 ocr LAND USE APPLICATION # Unknown <br />OWNER ADDRESS 3371 Odell Avenue <br />CITY/STATE/ZIP Stockton, CA 95206 <br />CONTRACTOR Gregg Drilling, LLC PHONE (925) 313-5800 <br /> <br />CONTRACTOR ADDRESS 950 Howe Road <br />CITY/STATE/ZIP Martinez, CA 94553 <br />Kleinfelder, Inc PHONE (209) 993-2269 SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br /> 2001 Arch Airport Rd, Suite 100 <br />CITY/STATE/ZIP Stockton, CA 95206 <br />LICENSE • C-57 0 C-61 0 D-09 0 Other NUMBER 1044456 EXPIRATION DATE 09/30/2022 <br />DEPARTMENT USE ONLY <br />tiot <br />Date S/a3A2 Area 1/5 Employee ID# -t1 <br />Date CI SPECIAL Well Permit <br />Date 0 WAIVER Received <br />Datet. Coristructed Well Depth ft <br />5pEclor 40 sLi•eitiiik on 23.. <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAzELroN AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />DOMESTIC WELL SAMPLING: E General Mineral/Coliforrn Bacteria (4391)0 Dibromochloropropane (4392) L Arsenic (4393) <br />INTENDED USE O Domestic/Private 0 Irrigation/Agricultural 0 Industrial 0 Water Quality Monitoring • Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />SAN , <br />Proposed Well Depth 70 to 100 ft Excavation 2 to 8 in diameter 0 Open Bottom 0 Gravel Pack/Gravel Sizt/EALT4.8symryi—ivTV <br />Conductor Casing in diameter / Conductor Casing Depth ft E.p,4RTTAL . <br />ME- v r Well Casing Diameter in Thickness/Gauge/ASTM Sched 0 Steel 0 Plastic 0 Stainless Steel 0 Other <br />Grout Seal Depth 70 to 100 ft • Neat Cement (94/b bag/5-10 gal water) 0 Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) • Other up to 5% bentonite <br />Grout Placement Method • Pumped 0 Free Fall M Other Tremie Full-Depth 0 Retardant / Accelerator (name) <br />PEDESTAL Installed By El Driller 0 Pump Contractor 0 Other <br />Concrete Pedestal °Dimensions: Width ft Length <br /> <br />ft Thick <br />in 0 Christy Box 0 Stove Pipe <br />PUMP 0 Submersible 0 Turbine 0 Other HP Pump Set ft Standing Water Level <br />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 />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS P1 <br />eIVOU'Vell 5U <br />PE <br />Codes <br />SC <br />Info <br />Received <br />By <br />Check#/ Amount <br />Remitted Date Permit/ <br />Swvice Request # Invoice # Well ID# <br />437? )SD a 2 exe_A-1" 16,aq 1:23 It ‘4()004-130401 <br />TYPE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification • Other one (1) cone penetrometer test soli:144,m <br />Monitoring Well(s) <br />Out-Of-Service Well <br /># of wells 0 Soil Boring(s) <br />0 Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /># ofborings •Geotechnical one (1) # oPec 6%- <br />New Pump 0 Pump Replacement 0 Pump Repair 0 Raise Well Casing AOC <br />23 202 2 WELL CONSTRUCTION <br />Drilling Method • Mud Rotary 0 Air Rotary • Auger 0 Cable Tool 0 Push Point 0 Other :SS32100V allS Page I of? <br />e))ti93 / NY 7 M4/ <br />EH0043-06 04/07/2022 Well Permit