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1 <br /> 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 /> N <br /> Joe ADDRESS 1950 Pori Road A at Port of Stockton(see attached exploration plan) CITYIZip Stockton 95203 m <br /> D <br /> CROSS STREET See"Job Address"above APN 14502004,14503001, PARCEL SIZE LAND USE APPLICATION# NA ° <br /> 14503012 m <br /> OWNER NAME Port of Stockton PHONE (209)946-0246 <br /> OWNER ADDRESS _PO BOX 2089 CITYISTATE/ZIP Stockton,CA 95201 <br /> CONTRACTOR Gregg Drilling and Testing,Inc. PHONE(925)313-5800 <br /> CONTRACTOR ADDRESS 950 Howe Rd. CITY/STATEOP Martinez,CA 94553 <br /> SUBCONTRACTOR NA PHONE <br /> SUBCONTRACTOR ADDRESS CITYISTATEIZIP <br /> LICENSE x C-57 C-61 : D-09 -Othef NUMBER 485165 EXPIRATION DATE September 2020 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) .Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring x Soil Sampling/Characterization <br /> Public Water System NA nr_ <br /> If different from Owner Walar System Name Conrad Name or Phone Number <br /> TYPE OF WORK New Well - Replacement Well Well Alteration/Modification Other % �a <br /> Monitoring Well(s) A of wells Soil Bonng(s) u°r b°rirx�s x Geotechnical 4 #°f b0""9' ®��® <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> _ New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION JOA <br /> Drilling Method X Mud Rotary Air Rotary _ Auger Cable Tool -Push Point _ Other / <br /> Proposed Well Depth 60 It Excavation c in diameter -..Open Bottom Gravel Pack/Gravel Size NA in diamet TV/YC)VM C04111 <br /> Conductor Casing NA in diameter / Conductor Casing Depth NA ft H�EpgQ Tq4 r L <br /> Well Casing Diameter NA in Thickness/Gauge/ASTM Schad NA Steel _ Plastic - Stainless Steel -Other <br /> Grout Seal Depth 60 ft x Neat Cement(94 Ib bag/5-10 gal water) _Sand Cement sack mix/7 gal water <br /> = Bentonite(20%solids) x Other_ Geotechnical borings will be backfilled(sealed)with neat cement grout. <br /> Grout Placement Method Pumped _ Free Fall X Other Tremie lube _ Retardant/Accelerator(name) <br /> PEDESTAL Installed By -.:Driller -Pump Contractor Other <br /> Concrete Pedestal-Dimensions:Width ft Length If Thick in Christy Box -Stove Pipe <br /> PuMP _SJbmersible-.Turbine _ Other HP Pump Set ft Standing Water Level H <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 C PENSATION LAWS. -1 <br /> w I M 48 HOUR ADVN99i QUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED f � � TITLE Associate Geotechnical Engineer DATE February 7,2019 <br /> See attached geotechnical exploration plan. <br /> / <br /> DEPARTMENT U E ONLY <br /> Application Accepted By / r'" Date Z � /�� Area rl Employee ID# �� t���• <br /> Grout Inspection B Date_ _ SPECIAL Well Permit <br /> Pump Inspection By Date r WAIVER Received <br /> Soil Boring Inspection By Dale Constructed Well Depth ft <br /> COMMENTS <br /> PE sC Received Check#1 Amount Permit/ <br /> Date Invoice# Well ID# <br /> Codes Into dash Remitted Se ice Re uest# <br /> � <br /> 5 — L I <br /> EHD 47-06 reined 4!1QI9 n^, r� !_ J/ WELL(PUMP PERMIT <br />