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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 /> Ul <br /> JOB ADDRESS West Ln Calaveras North Pump Station CITy/Zlp Stockton 95209 m <br /> D <br /> CROSS STREET West Ln.8 Calveras River Bike Ph APN 10437009 PARCEL SIZE 0.29 acres LAND USE APPLICATION# <br /> m <br /> OWNER NAME City of Stockton Municipal Utility Dept. Job#M16010 PHONE 209-937-8700 m <br /> OWNER ADDRESS 2500 Navy Drive CITY/STATE/ZIP Stockton CA 95206 <br /> CONTRACTOR Fewest Corrosion Control PHONE 510-952-6256 <br /> CONTRACTOR ADDRESS 2223 Commerce Place CITY/STATE/ZIP Hayward CA 94545 <br /> SUBCONTRACTOR n/a PHONE n/a <br /> SUBCONTRACTOR ADDRESS n/a CITY/STATE/ZIP n/a <br /> LICENSE ZC-57 [:]C-61 [—]D-09 Other NUMBER 248232 EXPIRATION DATE 12-31-2019 <br /> DOMESTIC WELL SAMPLING:0 General Mineral/Coliform Bacteria(4391)❑Dibromochloropropane(4392)0 Arsenic(4393) <br /> INTENDED USE Domestic/Private (n igation/Agricultural ndustrial D Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water SysteLLmJJ <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK 1/New Well D Replacement Well 0 Well Alteration/Modification ✓ Other <br /> ❑Monitoring Well(s) #of wells QSoil Boring(s) #of borings D Geotechnical #of Mngs <br /> []Out-Of-Service Well 0 Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> D New Pump D Pump Replacement D Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method EAud Rotary Q4ir Rotary D Auger D Cable Tool D Push Point ❑ Other <br /> Proposed Well Depth 45 it Excavation in diameter D Open Bottom ravel Pack/Gravel Size in diameter <br /> -Conductor Casing n/a in diameter / Conductor Casing De th n/a ft <br /> Well Casing Diameterc I Thickness/Gauge/ASTM Schad PVC Sch 80 Steel 11 Plastic ❑Stainless Steel 11ther <br /> Grout Seal Depth �t ✓❑Neat Cement(94 Ib bag/5-10 gal water) 0 Sand Cement sack mix/7 gal water <br /> D Bentonite(20%solids) D Other <br /> Grout Placement Method ✓[ umped G Free Fall 0 Other Tremmie ❑Retardant/Accelerator(name) <br /> PEDESTAL Installed By [Z]Driller ❑Pump Contractor LL.1 Other W-1 <br /> ❑Concrete Pedestal[]Dimensions:Width ft Length It:Thick in 7 Christy Box []Stove Pipe <br /> POMP []Submersible[]Turbine D Other NIA HP NIA Pump Set NIA ft Standing Water Level wA ft <br /> I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDI CES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIV WIT THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS,COMPEN TION AWS. <br /> MINIMU 48 UR ADVA)J, E OTICE REQUIRED FO I SPECT N PLEASE CALL(209)953-7697 <br /> SIGNED ��// "-- T DATE <br /> S E E P L A N S F O R D E T A I L S <br /> MENT <br /> EIVED <br /> i 4 2019 <br /> UIN COUNTY <br /> EPA TMENT US ONLY N TH ONMENTAL <br /> ! DEPARTMENT <br /> Application Accepted By Date Area Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER RBC@IVBd / /J <br /> Soil Boring Insp c.on By Date Constructed Well Depth ft <br /> COMMENTS 9`ry <br /> PE SC Received Check Amount Dae PermiU Invoice# Well ID# <br /> Codes B Remitted— Service Re uest# <br /> rg? <br /> EHD 43-08 revised 4114118 WELL/PUMP PERMIT <br />