Laserfiche WebLink
i WELLIPUMP PERMIT 2536 <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 <br />9190 Alhambra Ave. CITYIZIP Stock=/95212 <br />CROSS STREET Hlldreth Ln APN 086-440-39 PARCEL SIZE 0.56 LAND USE APPLICATION # <br />NAME lim Muss PHONE 209-931-9156 <br />OWNER ADDRESS Same as Above CITYISTATEIZIP <br />CONTRACTOR Delta Pump Inc. PHONE 209-466-9625 <br />CONTRACTOR ADDRESS 646 S California St CITYISTATErZIP StocKton/95203 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />LICENSE I C-57 X C-61 D-09 -- Other <br />PHONE <br />C ITYISTATEIZIP <br />NUMBER 1055434 EXPIRATION DATE 7/31/2023 <br />DOMESTIC WELL SAMPLING: 0 General Mineral/Coliform Bacteria (4391) 0 Dibromochloropropane (4392) 0 Arsenic (4393) <br />INTENDED USE <br />Domestic/Private rrigation/Agricultural - Industrial --Water Quality Monitoring coli <br />-: Iaampnnyn iicia�t <br />Public Water System Contact Name or Phone Number <br />If different from Owner. Water System Name <br />TYPE OF WORK 0 New Well -: Replacement Well <br />0 Monitoring Well(s) # of wells <br />0 Out -Of -Service Well <br />❑ New Pumo D Pump Replacement <br />Well Alteration/Modification <br />Soil Boring(s) <br />Out -Of -Service Well Renewal <br />VPumn Repair <br />Other <br /># or borings Geotechnical <br />Cross -Connection Repair <br />Raise Well Casinq <br /># of borings <br />WELL CONSTRUCTION <br />Drilling Method - Mud Rotary 0 Air Rotary - Auger - Cable Tool - Push Point - Other <br />Proposed Well Depth ft Excavation in diameter Open Bottom Gravel Pack/Gravel Size In diameter <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 ft 0 Neat Cement (94 Ib bag/5-10 gal Nater) Sand Cement sack mix/7 gal water <br />L Bentonite (20% solids) 0 Other <br />�. "I Dlncement Method Pumped -- Free Fall -. Other Retardant /Accelerator (name) <br />PEDESTAL Installed By Driller - Pump Contractor Other <br />Concrete Pedestal -.Dimensions. Width ft Length ft Thick <br />lin Christy Box Stove Pipe <br />T <br />m <br />m <br />D <br />0 <br />0 <br />m <br />m <br />co <br />N <br />PUMP X Submersible. Turbine Other HP 1.5 Pump Set ft Standing Water Level t <br />Plot Plan Requirements: Attach a plot plan isrth the exact location of water well with respect to the tollo, ,items GPS <br />Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing wells, structures, <br />potential sources of contamination, severs or private disposal systems. Include distance from two property lines. For Domestic, <br />Agriculture, Industrial well, protide location of an}. water *,ells or surface water within 200' radius of proposed «e11. <br />DEPARTMENT USE ONLY J <br />Application Accepted By �- l' C — Date <br />�7�P z Area Employee ID# Fr N(� <br />Grout Inspection By Date SPECIAL Wel! Permit <br />Pump Inspection By Date L(- ❑ WAIVER Received <br />Date Constructed Well Depth ft <br />Soil Boring Inspection By Z ( <br />COMMENTS �ZA, <br />PE SC Received <br />Codes Info Bv <br />3�' �a <br />Chec Amount Date <br />ash Remitted <br /># - �S J <br />Permit/ Invoice # Well ID# <br />Service Re uest # <br />4 <br />i <br />`l� tH�7p .�3:111t <br />EHD043-061015/2021 r°E' i °f, <br />