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TIA44 S�" Ola°^ <br /> WELLIPUMP 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 Stockton I-5 Post Mile 25 to 32.7 N <br /> cITYZP Stockton/95204,95207,95219 m <br /> a' <br /> CROSS STREET West March Lane ApN PARCEL SUE_LAND USE APPLICATION A <br /> OWNER NAME Caltrans Right of Way PHONE <br /> OWNER ADDRESS NA CRY/STATEZP <br /> CONTRACTOR Kleinfelder PHONE 916-366-1701 <br /> CONTRACTOR ADDRESS 2882 Prospect Park Drive Suite 200 CRY/STATEZP Rancho Cordova,CA 95670 <br /> SUBCONTRACTOR Kleinfelder PHONE 916-366-1701 <br /> SUBCONTRACTOR ADDRESS 2882 Prospect Park Drive Suite 200 CITY(STATEJZIP Rancho Cordova,CA 95670 <br /> LICENSE A C-57 l C-61 -1 10-09 1 Other NUMBER 467252 EXPIRATION DATE 12/31/16 <br /> GEOGRAPHICAL INFORMATION: Coordinates Y Township_ Range_ Section_ <br /> INTENDED USE l DomestidPrivate �InigalioNAgricultural �Industrial I Water Quality Monitoring a Soil Sampling/Characterization <br /> �Public Water System <br /> Ifdaemnlhom Owner: --------------Vialwpem ame Ona smear ne um e, <br /> TYPE OF WORK ' NEW Well n Replacement Well -'Well Alteralicn/Modificstion Other <br /> -1 Monitoring Wells) #of wells Soil Boring(.) SO berms. �Geotechnical 6 ser ennnsa <br /> '1 Out of-Service well Out-Of-Service Well Renewal �Coss-Connection Repair <br /> New Purno Pump Re lawmen I Pump Repair I Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method l Mud Rotary Air Rotary Auger 'Cggble Tool I Push Point l Other <br /> Ir fr <br /> Proposetl Well Depth ''45' it Excavations in diameter Open Bottom �Gravel PadJGrwel Sae in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth R <br /> Well Casing Diameter—in Thickness./Gauge/ASTM Schetl �Steel �Plastic �Stainless Steel �Other <br /> Grout Seal Depth 30 ft /Neat Cement(94 111 b.,/ IO gal Water) I Sand Cement sack moo gal water <br /> 'Bamori(20%solids) 1 Other <br /> Grout Placement Method -.Pumped Free Fall E101her Trerrlle Retardant/Accelerator(name) <br /> PEDESTAL Installed By �Driller I Pump Contractor Other <br /> Concrete Pedestal-1Dimenalons:Widdr ft Length itThick in 1 Christy Box �Si Pipe <br /> PUMP Submersible-1 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 ANP 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 OU DVANCE NOTrIIC-E-_REQU ED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> t}�eYhfA71d� TITLE Geologist DAM 7/26/2016 <br /> SIox60 Jull <br /> CEI r EE, <br /> C ;RM <br /> u 0 S 1016 <br /> O JENMENTALH IT/SERVICESLTH <br /> EWRSW <br /> OE <br /> HF�TMO weptetl ETMENT Uj66 <br /> E ONLY <br /> Application Date_EArea Employee ID# 0 <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE into Received Ch Amount pale Final Invoice# We1110# <br /> Codes Info B aah Remitted Service R est# <br /> EHo oe <br /> 4Gw12 WELLFUMP PERMIT <br />