Laserfiche WebLink
t , <br /> 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.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> JOB ADDRESS 26901 Hansen Road(see map) CITYIzIP Tracy,CA 95377 � <br /> CROSS STREET None APN 209-110-100-000 PARCEL SIZE`75 acres LAND USE APPLICATION# <br /> OWNER NAME Costco Wholesale PHONE (425)313-6052 <br /> to <br /> OWNER ADDRESS 999 Lake Drive CIN/STATEIZIP Issaquah,WA 98027 <br /> CONTRACTOR V&W Drilling PHONE (209)469-7700 <br /> CONTRACTOR ADDRESS 3806 Duck Creek Drive CITY/STATE/ZIPStockton,CA 95215 <br /> SUBCONTRACTORICONSULTANT Klelnfelder Inc. PHONE (408)840-1038 <br /> SUBCONTRACTORICONSULTANT ADDRESS 380 North First Street,Suite A CITY/STATE/ZIP San Jose,CA 95112 <br /> LICENSE x C-57 C-61 D-09 -Other NUMBER 724904 EXPIRATION DATE April 30,2022 <br /> BILLING PARTY: OWNER _CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private IrrigationlAgricultural Industrial Water Quality Monitoring x 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 Replacement Well Well Alteration/Modification Other <br /> MonitoringWell(s) #of wells SoilBoring(s) #of borings x Geotechnical 3 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal i Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION(NO WELLS ONLY GEOTECHNICAL BORINGS) <br /> Drilling Method Mud Rotary Air Rotary AAuger Cable Tool L Push Point Other <br /> Proposed Well Depth 10 —:50 It Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth It <br /> Well Casing Diameter ins Thickness/Gauge/ASTM Sched ; Steel Plastic Stainless Steel Other <br /> Grout Seal Depthsbft X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix(1 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method APumped x Free Fall Other Retardant/Accelerator(name) <br /> Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions.Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set It Standing Water Level It <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 8 H/(3gIRjA� � �(r��c��\\O\)TICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED �+j„ tom° TITLE Staff Professional-Kleinfelder Inc DATE 8/13/2020 <br /> YMENT <br /> 1 T1CEIVED <br /> 19 2020 <br /> MA QUIN COUNTY <br /> PONMENTAL <br /> A L7 DEPARTMENT <br /> DEPARTMENT USE ONLY _ <br /> Application Accepted By � Date Cl/9 d 0p10 Area Employee ID#_yK <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date /n� WAIVER Received <br /> Soil Boring Inspection By Date O 3 �Z� Constructed Well Depth ft <br /> CQVMI�NTS 1 n ,)n 1 1 t tC�I ff pipe <br /> Is Pioi►i , �bl >t ye ku rt7e J1 lYl <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# cAepl�fi <br /> Codes Into Cash Remitted Service Request# <br /> E437d sOz76© zb I(P <br /> EHD43-06 6/11/2019 WELL/PUMP PERMIT <br />