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WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE -STOCKTON CA 95205 - (209) 488-3420 <br />963-IUVI FOR INSPECTIONS EXPIRES 7 YEAR FROM GATE ISSUED <br />Joe ADDRESS 29011 Corral Hollow Road <br />CRY/71P <br />Tracy i 55377 <br />CROSS STREET Mendota Canal APN 25311030 <br />PARCEL SIZE 2 <br />LAND USE APPLICATION# <br />OWNER NAME Bureau of Reclaimation fU-rl(Lip �i/ <br />PHONE <br />OWNER ADDRESS 15590 Kelso Road <br />CITY/STATE/LP <br />gy-on, CA <br />CONTRACTOR EHGEO Inc. <br />PHONE 209-684-7611 <br />CONTRACTOR ADDRESS 17278 Golden Valley Parkway <br />CRY/STATEIZP <br />Lathrop / CA / 95330 <br />Paul Britton Zt� <br />SUBCONTRACTOR <br />� <br />PHONE 408-355-5781 <br />SUBCONTRACTOR ADDRESS PO Box 2261 <br />CITY/STATE/71P <br />Los Gatos, CA 95031 <br />LICENSE X C-57 _ C-61 .., D-09 _ Other <br />NUMBER849905 <br />EXPIRATION DATE 11/2018 <br />GEOGRAPHICAL INFORMATION: Coordinates X_j}.6-IIS 111 Y-111. 11 r4, F. -11!± Township_ Range Section <br />INTENDED UAE Domestic/Private Irrigation/Agricultural ; Industrial Water Quality Monitoring It Soil Sampling/Charactedzation <br />Public Water System <br />If diaererd from Owner: Water bystem eme Contiig Name or PhomNi—Sw <br />TYPE OF WORK - New Well _. Replacement Well Well Alteralion/Motlification ,- Other <br />Monitoring Well(s) # of wells x Soil Boring(s) 2 eof bongs Geotechnical a of boonp <br />_ <br />Out -Of -Service Well Out -Of -Service Well Renewal ._. Cross -Connection Repair <br />Drilling Method Mud Rotary Air Rotary x Auger Cable Tod i Push Point Other <br />Proposed Well Depth 70-100 it Excavation 6 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 r- Stainless Steel Other <br />Grout Seal Depth 70-100 ft x Neat Cement (94 Ib bag/5-10 gal water) Sand Cement sack mixf7 gal water <br />- Bentonite (20q solids) 7. Other <br />Grout Placement Method -Pumped z Free Fall Other _ Retardant / Accelerator (name) <br />PEDESTAL Installed By ._ Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width it Length it Thick in Christy Box Stove Pipe <br />UMP - Submersible - Turbine Other HP Pump Set ft Standing Water Level ft <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 CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAWS. <br />�-MINIMUM 24 HOUR AD �NCCEENNOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED.Y i :� j-"� TITLEProject Engineer DATE 4-13-18 <br />H <br />pq��F <br />Fc,_Nr <br />16 ?418 <br />W <br />W"'A"'r <br />PA TMENTT USE <br />Accepted By / I I/ Date Area Employee 10#41�� <br />Grout Inspection By 1 Date SPECIAL Well Permit <br />Pump Inspection By C Date WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth tt <br />COMMENTS <br />PE SC Received Check#1 <br />Codes Info B Cash <br />Amount Data Permit/ Invoice# Well IDN <br />Remitted Service Request # <br />1 sU i <br />Ll l� 13' WI000 <br />EH O 4304 (3+I `7 �/ t� lJ �� WELL (PUMP PERMIT <br />n)90/12 <br />