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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS BNSF Mariposa Yard, Stockton Internmodal Facility CITY/ZIP _ _ Stockton, 95215 <br />CROSS STREET Arch Road APN 18109021 _,/ 181�d07 7-7—PARCEL <br />%PARCEL SIZE 56.15 aCreLAND USE APPLICATION # <br />OWNER NAME BNSF Mariposa Yard, Stockton Intermodal Facility <br />PHONE <br />OWNER ADDRESS 6200 South Austin Road <br />CITY/STATE/ZIP Stockton, California, 95215 <br />CONTRACTOR V8'W Drilling <br />CONTRACTOR ADDRESS 1133 Blackhurst Drive <br />SUBCONTRACTOR Mid Pacific Engineering <br />CITY/STATEIZIP <br />PHONE 209-469-7700 <br />Galt, CA, 95632 <br />PHONE 916-767-8082 <br />SUBCONTRACTOR ADDRESS 840 Embarcadero Drive, Suite 20 CITYISTATE/21P West Sacramento, CA, 95605 <br />LICENSE X C-57 J C-61 ._ D-09 .. Other NUMBER 720904 4/30/2024 <br />ExPIRATIDN DATE <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE L Domestic/Private a Irrigation/Agricultural J Industrial Water Quality Monitoring i 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 />See Site plans J Monitoring Well(s) # of wells .- Soil Boring(s) # of borings x; Geotechnical 9 # of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />New Pump Pump Replacement C Pump Repair - Raise Well Casinn <br />Drilling Method _ Mud Rotary "- Air Rotary X Auger C Cable Tool : Push Point _ Other <br />Proposed Well Depth 15-50 ft Excavation 6 n diameter Open Bottom 7 Gravel Pack/Gravel Size <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other_ <br />Grout Seal Depth 15750 ft A Neat Cement (94 lb bag/5-10 gal water) I Sand Cement sack <br />Bentonite (20% solids) Other <br />Grout Placement Method J Pumped x: Free Fall x Other tremie Retardant / Accelerator (name) <br />in <br />mamneu Dy i_I ureter J Pump Contractor <br />Concrete Pedestal =Dimensions: Width _ <br />Christy Box _. Stove Pipe <br />Other <br />ft Lengtt <br />in diameter <br />rn <br />f <br />m <br />D <br />con M <br />w <br />ft Thick <br />AQU C' UNTY <br />AL <br />Pump Set ft Standing Water L LTH DEPAtR ENT <br />PUMP Submersibles_: Turbine: Other HP Pum <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 />-.I I\HILL 24 1101, k AD1 ANCE NOFICE 14EQ1 110"D I -ON tItiSPECTIO\S - I'LF:ASE ('ALL 1209) 953-769i <br />DEPARTMENTCUS/ ON Y <br />C/ <br />Application Accepted By Date ! ZZ Area ` Fmployee ID# <br />Grout Inspection By Date SPECIAL W011 Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date �\,� ��structed <br />Well Depth ft <br />COMMENTS <br />PE SC Received Check#/ Amount Permit/ <br />Codes Info B as Remitted Date Service Request # Invoice # Well ID# <br />Y372 �s o /7/(o - - <br />I <br />Paye I of 2 <br />��_� <br />366 <br />6,L <br />lli Well i Pump Permit <br />