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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 wVVVV.siqov.oraleh,1 EXPIRES'I YEAR FROM DATE ISSUED N <br /> 2222 S.Sinclair Avenue CITYIZIP Stockton,95215 <br /> m <br /> JOB ADDRESS D <br /> 0 <br /> CROSS STREET Farmington Rd APN 173-150-1801173-150-190 PARCEL SIZE 11.56 LAND USE APPLICATION# a <br /> M <br /> N <br /> OWNER NAME Sinclair Partners LLC PHONE H <br /> OWNER ADDRESS <br /> PO Box 60607 CITY/STATE/ZIP Palo Allo.CA,94306 <br /> CONTRACTOR <br /> Cornerstone Earth Group PHONE 408.2454600 <br /> CONTRACTOR ADDRESS <br /> 1259 Oakmead Parkway CITY/STATEIZIP Sunnyvale,CA.94085 <br /> SUBCONTRACTOR/CONSULTANT <br /> Middle Earthg' <br /> Geo Testing,Inc PHONE 714-633-5025 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS <br /> 954 N Lemon Street CITY/STATE/ZIP Orange,CA.92867 <br /> LICENSE <br /> X C-57 C-61 D-09 Other NUMBER 899451 EXPIRATION DATE 06/3012021 <br /> BILLING PARTY: OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> tt <br /> Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring X Soil Sampling/Characterization <br /> Public Water System <br /> II tllfferemlrom Owner Water System Name Contact Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modif.cation Other <br /> a of boring, x Geotechnical 7 k of borings <br /> Monitoring Well(s) #of wells x Soil Boring(S) <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pum2 Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Cone Penetration Test <br /> Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point x Other <br /> Proposed Well Depth 150 fl Excavation 2 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter I Conductor Casing Depth_it <br /> Well Casing Diameter_in Thickness/Gauge!ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depthil�& _ft X Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mW7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped Free Fall x Other tremfe Retardant/Accelerator(name) <br /> PEDESTAL 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 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 1 AM IN COMPLIANCE WITH ALL <br /> WORKERS OMPENSATION LAWS. >> <br /> M It UM HOUR ADVANC NOTICE REQUIRED F021 SPEC 4 S- LEAS`CALL( 9)953-7697 <br /> SI TITLE <br /> ist�1 ATE Kr-Lv-2o2C� <br /> MENT <br /> QED <br /> 28 2020 <br /> NMENTA NTy <br /> PARTMENT <br /> HII <br /> DEPARTMENT USE O LY <br /> Application Accepted By �/�"�`� Date 1a �� 042/0 Area � Employee ID# DA <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By L'f_ _.S(v JAL2 4x L Date Constructed Well Depth k <br /> COMMENTS <br /> PE Sc Received Cheek#I Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Awl CasJi Remitted Service Request <br /> y37d SO <br /> EHD 47-0ri tilt t20t5 /� 1 r--/ DID <br /> WELL(PUMP PERMIT <br />