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r . 4 <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232 (209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> fn <br /> JOB ADDRESS D Hwy 4 PM 7.18-8.10 (Caltrans Right-of-Way) CITY/ZIP Stockton,CA,95206 m <br /> CROSS STREET Bacon Island Road APN/VPC• I S 111100 / PARCEL SIZE 4 1 1 LAND USE APPLICATION# Unknown A <br /> m <br /> OWNER NAME Caltrans-Division of Engineering PHONE (916)277-1040 N <br /> OWNER ADDRESS 5900 Folsom Boulevard CITYISTATE21P Sacramento,CA 95819 <br /> CONTRACTOR Exequiel Sinco/Kleinfelder, Inc. PHONE (559)270-6349 <br /> CONTRACTOR ADDRESS 2882 Prospect Park Dr.,.Suite 200 CITYISTATE/ZIP Rancho Cordova,CA 95670 <br /> SUBCONTRACTOR/CONSULTANT PHONE <br /> SUBCONTRACTOR/CONSULTANT ADDRESS CITYISTATE/ZIP <br /> LICENSE 0 C-57 C-61 D-09 Other NUMBER 467252 EXPIRATION DATE 12/31/2020 <br /> BILLING PARTY: OWNER CONTRACTOR 0 SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial � Water Quality Monitoring 0 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 E Other eight(8)cone penetrometer test soundings <br /> Monitoring Well(s) #of wells Soil Boring(s) 4 of borings 0 Geotechnical five 5 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump 'J Pump Replacement i Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ■Mud Rotary Air Rotary Auger Cable Tool Push Point ■ Other eight(8)cone penetrometer test soundings <br /> Proposed Well Depth 40 ft Excavation 2-6 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 Stainless Steel Other <br /> Grout Seal Depth i 'O ft 0 Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method N Pumped Free Fall 0 Other Tremie Full-Depth ._ Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal _Dlmenslons:Width ft Length It Thick in Christy Box Stove Pipe <br /> PUMP _ 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 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED Exequiel Sincoi ':T',-"^,':'i"'"„-""-'""" TITLE Professional Engineer(No.84010) DATE <br /> F <br /> RYMENT <br /> CFS AFD <br /> JUS <br /> 072020 <br /> Sea c e o s d )o in I aio 0-4 NC <br /> HID pq 41�Al�' <br /> MENr <br /> may- /DEPARTMENTU E ONLY <br /> `� .12 p 1 /( <br /> Application Accepted By !/�"� "'� Date / G Od b Area J (I�I Employee ID# SK <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring�Ipection B�yV pate Vb 1%'Z-1 7�Zo Constructed Well Depth ft <br /> COMMENTS /e1PGk'r t5y;,l .ZS G:1'G Kc;( I?CA- . I- <br /> PE <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info RWI Cash Remitted Service Re es # <br /> 937d IS-0a� s N� tD/rsi?.o7.� <br /> EHD 43-06 6/11/2019 6X4 —1 ��V ���V � / WELL/PUMP PERMIT <br />