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f <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE -STOCKTON CA 95205 - (209) 468-3420 <br />14UN-KEI-UNUABLE YERMI I GALL LUy V0J-rbyr FUR INSPEGTION5 CAYIKtS l TEAR FROM DATE ISSUED <br />JOB ADDRESS 1222 Frontage Rd <br />ctTY/zIP Ripon 95366 <br />CROSS STREET N Highland Ave APN 22811016 <br />PARCEL SIZE3.56 ac LAND USE APPLICATION# <br />OWNER NAME Pacific Gas & Electric Co <br />of PHONE PG&E <br />OWNER ADDRESS 6121 Bollinger Canyon Rd <br />0 CITY/STATE/zIP San Ramon, CA 94583 <br />CONTRACTOR Kleinfelder <br />PHONE (800) 743-5000 <br />CONTRACTOR ADDRESS 3731 W.Ashcroft Ave <br />CITY/STATE/TJP Fresno, CA 93722 <br />SUBCONTRACTOR Taber Drilling <br />PHONE (916) 371-8234 <br />SUBCONTRACTOR ADDRESS 536 Galveston St <br />CITY/STATE/ZIP West Sacramento, CA 95691 <br />LICENSE R C-57 O C-61 ❑ D-09 ❑ Other <br />NUMBER 969927 EXPIRATION DATE 02/2812018 <br />DOMESTIC WELL SAMPLING: I I General Mineral/Coliform Bacteria (4391) 1 1 Dibromochloropropane (4392) 1 1 Arsenic (4393) <br />NTENDED 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 Nam or Phone Number <br />TYPE OF WORK ❑ New Well ❑ Replacement Well ❑ Well Alteration/Modification ❑ Other <br />❑ Monitoring Well(s) # of wells ❑ Soil Boring(s) # of borings ® Geotechnical 1 # of borings <br />❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal ❑ Cross -Connection Repair <br />new <br />Drilling Method 2 Mud Rotary ❑ Air Rotary 9 Auger ❑ Cable Tool ❑ Push Point ❑ Other <br />Proposed Well Depth 50 ft Excavation 6" in diameter ❑ Open Bottom ❑ Gravel Pack/Gravel Size in diameter <br />❑ Conductor Casing in diameter / Conductor Casing Depth It <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Schad ❑ Steel ❑ Plastic ❑ Stainless Steel ❑ Other <br />Grout Seal Depth 50 ft 6 Neat Cement (94 /b bag/. 10 gal water) ❑ Sand Cement sack mix/7 gal water <br />❑ Bentonite (20% solids) ❑ Other <br />Grout Placement Method 19 Pumped ❑ Free Fall ❑ Other ❑ Retardant / Accelerator (name) <br />PEDESTAL Installed By ❑ Driller ❑ Pump Contractor ❑ Other <br />❑ Concrete Pedestal ODimensions: Width ft Length ft Thick in ❑ Christy Box ❑ Stove Pipe <br />PUMP D Submersible❑ Turbine ❑ Other HP Pump Set it 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 />MJULMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE VP / Exploration Coordinator DATE 01.19.2016 <br />_N <br />M <br />/s�AR MENT U E �Y L } <br />Application Accepted By ` Date Area Employee ID#�C��/ <br />Grout Inspection By Date01 ❑ SP CIAL Well Permit <br />Pump Inspection By Date ❑ WAIVER Received <br />Soil Boring nspection By Date Constructed. Well epth <br />COMMENTS <br />EHD 43-06 8/01/16 /" �l D7�053 WELL/PUMP PERMIT <br />