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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.% ov.or /ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> JOB ADDRESS 6001/6401 South French Camp Road CITYtZIP French Camp/95231 <br /> 193-060-350& acres D <br /> CROSS STREET Yettner Road APN 193-060-11 ++ PARCELSIZE 19.13 LAND USE APPLICATION# NA o <br /> OWNER NAME AJVP Ranch LLC ++adjoining/contiguous parcels PHONE (209)952-7822 m <br /> OWNER ADDRESS 8236 Arroyo Way CITY/STATEIZIP Stockton,CA 95209-2458 <br /> O <br /> O <br /> CONTRACTOR GeoEX Subsurface Exploration,Inc. PHONE (916)799-8198 <br /> A <br /> CONTRACTOR ADDRESS 1510 Madera Drive CITY/STATE/ZIP Dixon,CA 95620 0 <br /> SUBCONTRACTOR/CONSULTANT Bajada Geosciences,Inc. PHONE (530)638-5263 0 <br /> C <br /> SUBCONTRACTORICONSULTANTADDRESS 28301 Inwood Road CITY/STATE/ZIP Shingletown,CA 96088 <br /> T <br /> LICENSE ■C-57 C-61 D-09 Other NUMBER 954267 ExPIRATION DATE 7/31/2020 ro <br /> n <br /> n <br /> BILLING PARTY: OWNER CONTRACTOR I SUBCONTRACTOR/CONSULTANT <br /> n <br /> o, <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) 3 <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring ■Soil Sampling/Characterization X <br /> Public Water System NA NA w <br /> If different from Owner: Water System Name Contact Name or Phone Number PL <br /> TYPE OF WORK New Well Replacement Well D Well Alteration/Modification Other NA T <br /> N <br /> Monitoring Well(s) 0 #of wells D Soil Boring(s) 0 #of borings III Geotechnical 8** #of borings :3 <br /> Out-Of-Service Well D Out-Of-Service Well Renewal Cross-Connection Repair <br /> .+- <br /> 6 of which will be conei <br /> New Pump Pump Replacement D Pump Repair Raise Well Casing penetrometer soundings o, <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary 11 Air Rotary ■Auger Cable Tool Push Point Other NA n <br /> Proposed Well Depth 10-50 ft Excavation 2"-8.25" in diameter Open Bottom Gravel Pack/Gravel Size NA in diameter D <br /> Conductor Casing NA in diameter / Conductor Casing Depth NA ft <br /> Well Casing Diameter NA in Thickness/Gauge/ASTM Sched INA Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 10-50 It ■Neat Cement(94 Ib bagl5-10 gal water) Sand Cement NA sack mixl7 gal water <br /> Bentonite(20%solids) Other NA <br /> Grout Placement Method I Pumped Free Fall i I Other NA Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller Pump Contractor Other NA <br /> Concrete Pedestal Dimensions:Width NA ft Length NA ft Thick NA in Christy Box _'Stove Pipe <br /> PUMP Submersible Turbine Other NA HP NA Pump Set NA It Standing Water Level NA 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 /> MINIM4 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNEDX!Z_ -- TITLE Principal GeologistlBajada Geosciences DATE 6/4/2020 <br /> FFNT <br /> l QED <br /> Z020 <br /> M� �NTy <br /> T MFNT <br /> /9 DEPARTMENT USE ONLY <br /> Application Accepted By e Date �J ���L7 Area Employee ID# ,K <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date T!I - Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Amount Date Perm iv Invoice# Well ID# <br /> Codes Info Cash Remitted Service Re uest# <br /> sI i� 3IS0 $i <br /> EHD 43-06 6/112019 WELL/PUMP PERMIT <br />