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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL A DEPT 1868 East Hazelton Avenue- TON CA 95205-6232-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED / <br /> 0 <br /> JOB ADDRESS 8700 Thorton Rd CITY/ZIP Stockto 95209 jb <br /> Davis Road 072-420-15 <br /> CROSS STREET APN PARCEL SIZE O.2 3 BLAND USE APPLICATION# m <br /> w <br /> OWNER NAME Richard Sola PHONE fn <br /> OWNER ADDRESS 10341 Creek Trail Circle CITY/STATE/ZIP Stockton, CA 95209 <br /> CONTRACTOR Tim Cook PHONE 925-478-SVOO <br /> CONTRACTOR ADDRESS 1485 Treat Blvd, Ste 203A CITY/STATE/ZIP Walnut Creek,,,- Ca 94597 <br /> SUBCONTRACTOR Penecore Drilling PHONE <br /> SUBCONTRACTOR ADDRESS 1238 Alice St CITYISTATEZP woodland CA 95776 <br /> LICENSE I:I C-57 J C-61 D-09 I Other Ar Hat NUMBER 921387 EXPIRATION DATE <br /> GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br /> INTENDED USE Domestic/Private n Irrigation/Agricultural 0 Industrial X Water Quality Monitoring C Soil Sampling/Characterization <br /> Public Water System <br /> If different from Owner: Water bystern Narne contact arae or hone NUmber <br /> TYPE OF WORK r- New Well -i Replacement Well -'Well Alteration/Modification a Other <br /> `j #of borings ]GeoteChnlcal If of borings <br /> _ Monitoring Well(s) #of wells�Soil Borings) <br /> Out-Of-Service Well -I Out-Of-Service Well Renewal i Cross-Connection Repair <br /> New Pump 0 Pump Replacement G Pump Repair -. Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method L Mud Rotary i i Air Rotary )(Auger I- Cable Tool i i Push Point 0 Other <br /> Proposed Well Depth :SO _ft Excavation in diameter 0 Open B tom L Gravel Pack/Gravel Size in diameter <br /> L Conductor Casing '?1 in diameter / Conductor Casing Depth N 1`l ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched L Steel I Plastic n Stainless Steel Other <br /> Grout Seal Depth ft Xi Cement(94/b bag/5-10gal water) -I Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) r Other <br /> Grout Placement Method L Pumped L Free Fall 0 Other ,Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑ Driller II Pump Contractor L Other <br /> Concrete Pedestal Dimensions:Width It Length ft Thick in i Christy Box "i Stove Pipe <br /> PUMP [. Submersible I Turbine i-]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 /> INIMUM 24 ,UR ADVANCE NOTICE REOU]((,j,y'ED FOR IRSPECTI NS _ <br /> TITLE S ,tR! - DATE <br /> 11'1714 111 <br /> Al <br /> i <br /> DEPARTMENT USE ONLY <br /> Application Accepted By Date Area Employee ID# <br /> Grout Inspection By Dale SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Dale Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B Cash Remitted Service Request# <br /> EHD 43-06 WELL/PUMP PERMIT <br /> 8/04/08 <br />