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WELL/PUMP 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 /> to <br /> JOB ADDRESS Corral Hollow Rd CrrY/ZIP Tracy,CA 95376 m <br /> D <br /> Schulte 240-010-07 < <� o <br /> CROSS STREET APN PARCEL SIZE��LLAND SE APPLICATION# m <br /> OWNER NAME Union Pacific Railroad Company PHONE <br /> OWNER ADDRESS 4324 Pacific Street CITYISTATE/ZIP Rocklin,CA 96577 <br /> CONTRACTOR Technicon Engineering Services PHONE 559-994-7486 <br /> CONTRACTOR ADDRESS 4539 N.Brawley Ave.,Suite 108 CITY/STATE/ZIP Fresno,CA 93722 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZIP <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 767888 EXPIRATION DATE 8/31/15 <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE Domestic/Private Irngation/Agricultural Industrial Water Quality Monitoring X Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner Water tiysteM O" Uented N­r Ph.n. um er <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells X Soil Boring(s) 3(20ft.) #of borings X Geotechnical 3 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Reai Raise Well Casing <br /> WELL CONSTRUCTION `» <br /> Drilling Method Mud Rotary Air Rotary XAuger Cable To LHP t r f <br /> Proposed Well Depth 20 ft Excavation 8 n diame1� Open Botto Gra el n meter <br /> Conductor Casing n diameter / Conductor Ca�Q �ft <br /> Well Casing Diameter in Thick) uge/ASTM Sched 1. Stee i rp�y!/�' 0 er <br /> Grout Seal Depth 20 ft X Nea Cement(94/b bag/5-1 'belong t" " W� x/7 gal water <br /> Bentonite(20%solids) Other j�V{J <br /> Grout Placement Method X Pumped Free Fall Other e <br /> (PEDESTAL Installed By Driller Pump Contractor Other LJIVIRIAn <br /> L Concrete Pedestal Dimensions:Width It Length ft Thick in Christy 86ove Pipe <br /> [PUMP 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 /> M IMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> T nicon Engineering Services,Inc. President/CEO Z 1 <br /> SIGNED Darren G.Williams TITLE DATE <br /> It <br /> E ATTAIC HEQ <br /> 22015 <br /> SA <br /> N q�NTy <br /> E <br /> RTMENT <br /> I <br /> 11T 4t—q#-- <br /> DEPARTMENT USE ONLY p� <br /> Application Accepted By � Alko-h Date I'17 Area oyee ID# TU <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date J WAIVER Received <br /> Soil Boring Inspection By Dale Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Peck#y Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Remitted Service Re uest# <br /> 4 7-Z 5375- l i -�ito0`71 D£ <br /> EHD 43-06 <br /> 4/30112 WELL/PUMP PERMIT <br />