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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 in front of 321 E 5th Street(on E 5th St) CITY/ZIP Stockton,CA 95206 <br /> D <br /> CROSS STREET S Sutter Street APN 16704511 PARCEL SIZELAND USE APPLICATION# A <br /> m <br /> OWNER NAME PG&E/Tommy Edwards PHONE 661-330-2691 w <br /> OWNER ADDRESS 2600 Camino Ramon CITY/STATE/ZIP San Ramon,CA 94583 <br /> CONTRACTOR Bernard Pipeline Inc. PHONE 530-669-5810 <br /> CONTRACTOR ADDRESS 21 Pioneer Ave CITYISTATE17JP Woodland,CA 95776 <br /> SUBCONTRACTOR Cascade Drilling LLP PHONE 916-638-1169 ext 2334 <br /> SUBCONTRACTOR ADDRESS 3000 Duluth Street CITYISTATE/ZIP West Sacramento,CA 95691 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 938110 EXPIRATION DATE 9/30/2018 <br /> DOMESTIC WELL SAMPLING: -General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)_Arsenic(4393) <br /> INTENDED USE Domestic/Private -.i Irrigation/Agricultural X Industrial =Water Quality Monitoring i Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well I Replacement Well Well Alteration/Modification X Other Cathodic Protection Well <br /> MonitoringWell(s) #of wells SoilBoring(s) #of borings Geotechnical #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> - New Pump Pump Replacement Pump Repair Raise Well CasingL <br /> WELL CONSTRUCTION 1 <br /> Drilling Method _ Mud Rotary Air Rotary Auger Cable Tool - Push Point $ Other Sonic CA�O� <br /> Proposed Well Depth 200' ft Excavation 8" in diameter Open Bottom Gravel Pack/Gravel Size Coke Gree- in diaA r �® <br /> -Conductor Casing N/A in diameter / Conductor Casing Depth ft q <br /> Well Casing Diameter 2" in Thickness/Gauge/ASTM Schad 2:SCH 40 Steel X Plastic Stainless Steel 1 1 Other ? �O <br /> Grout Seal Depth 96' ft Neat Cement(94/b bag/5-10 gal wafer) Sand Cement sack mixl7 11, 19 <br /> Bentonite(20%solids) -Other //�/`.O <br /> Grout Placement Method x Pumped Free Fall -Other Retardant/Accelerator(name) T/Al / <br /> PEDESTAL Installed By X Driller -Pump Contractor Other <br /> Concrete Pedestal-Dimensions:Width It Length ft Thick in -Christy Box Stove Pipe T <br /> PUMP �i Submersible 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 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 /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE V.P Operations DATE 7/30/2019 <br /> tl t lalh <br /> A M E N T U VE O L Y <br /> Application Accepted By ^ Date Area Employee ID#- � <br /> Grout Inspection By MS41611114 Date!I�Z/ SPECIAL WeII Permit <br /> Pump Inspection By Date F WAIVER Received <br /> Soil Boring Inspecuo By Date��'� Constructed Well Depth ft <br /> COMMENTS JL� {/LEQ. LelKPill? <br /> PE SC Received heck#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info 13WA Remitted Service 59MV,# <br /> Z <br /> EHD 43-6 revised 4114/18 WELL/PUMP PERMIT <br /> 4 <br />