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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)488-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> Joe ADDRESS 6800 EI Dorado Street CITY/LP San Joaquin County,CA y <br /> a <br /> CROSS STREET French Camp Road APN 2 iO O -/ 3PARCEL SIZE LAND USE APPLICATION o A <br /> OWNER NAME Newport Carriers Incft-ab';, iN PHONE 510-779.6644 <br /> OWNER ADDRESS 26228 Industrial BoulevardAtli YJSTATE/LP Hayward,CA 94545 <br /> CONTRACTOR Kr ian g Associates.Inc PHONE 5^9.348.22UO <br /> CONTRACTOR ADDRESS 215W Dakota Avenue CITIISTATEIZIP Clovis.Cold,imia 93612 <br /> SUBCONTRACTOR Krazan 8 Assodales,Inr, PHONE 559 348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W Dakola Avenue CITYISTATFJZiP i.,lov.5.CRlifcpu.93612 <br /> LICENSE /C-57 C-61 D-09 Other NUMBER "-- EXPIRATION DATE 10 31 2018 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domesbc Pnvate IrrigaliONAgricultural Industrial Water Quality Monitoring Soil Sampling/Charactenzalion <br /> Public Water System <br /> If different It—Owner Wever System Name Comact name in Pnane Number <br /> TYPE OF WORK n New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Well(S) 0 O Wells Soil Boring(s) 0.!ti 1ngn ✓Geotechnical 6 sorcoiing: <br /> Out-Of-Service Well out-of-Service Well Renewal Cross-Conneclien Repair—(1II=50Feet) <br /> New Pum Pump Replacement Pump Re alt Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary I Air Rotary y/Auger Cable Tool Push Point Other <br /> Proposed Well Depthloi•S-J it Fxcavatron in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing In diameter / Conductor Casing Depth h <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Deplhij--o_If ✓Neat Cement(94 1b bagl5-10 gat water) Sand Cement sank mrx17 gal water <br /> Bentonite(20%solids) Other - 70 <br /> Grout Placement Method Pumped Free Fell Other RetardantI Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions Width R Length It Thick in Christy Boz Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set fl Standing Water Levet N <br /> I HEREBY CERTIFY THAT 1 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 HOURADyANC#NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED —�.---- / t TITLE L1anOJutg Engmt, DATE 03/27/2019 <br /> t <br /> NT <br /> ED <br /> 2019 <br /> COUNTY <br /> ENTAL <br /> A97MENT <br /> I <br /> FTM NLYApplication Accepted By &I Area ( �T Employee IDD <br /> Grout Inspection By Date SPECIAL WeII Permit <br /> Pump Inspection By _ Date WAIVER Received <br /> Soil Boring Inspection By T Date L Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Che Amount Permit/ <br /> odes Into ash em ed i Date Service RequestM InvoiceX Well ID# <br /> 4 <br /> EMO 43-05 rev:,vl Vta/te +'.'ELL/PUMP PERMIT <br />