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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.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESSI Stockton CA 95206 to <br /> N Zuckerman Rd (� J(GPS:37.98(s,�op0 oc/ PARCEL SIZE 121.47�'ir.�tL CITY/ZIP/ m <br /> CROSS STREET_ N Zuckerman Rd 6f �.r a APN_ �a(� 0 O J b-' 0 <br /> LAND USE APPLICATION# oM <br /> PC- ,-I' <br /> 1 P, m <br /> OWNER NAME I f-,-1 (I G L7(1S j E IE6(. _ PHONE vi <br /> OWNER ADDRESS P•J ES�X 7 700w-')�- CITY/STATE/ZIP '5'.G11 %/ 77 <br /> CONTRACTOR Underground construction Co. PHONE 707-741-1761 <br /> CONTRACTOR ADDRESS 5145 Industrial Way CITY/STATE/ZIP Benicia,CA 94510 <br /> SUBCONTRACTOR/CONSULTANT Corrpro Companies Inc-, PHONE 510-509-4993 <br /> SUBCONTRACTORICONSULTANT ADDRESS 2625c Barrington Court CITY/STATE/ZIP Hayward Ca 94545/ <br /> LICENSE ♦ C-57 C-61 D-09 Other NUMBER 764878 EXPIRATION DATE 06/30/2021 <br /> BILLING PARTY: OWNER CONTRACTOR ,/SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring 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 o' hoelf' I/e <br /> Monitoring Well(s) #of wells Soil Boring(s) #of borings Geotechnical #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method V/Mud Rotary Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth 300 ft Excavation 81, <br /> in diameter Open Bottom VfGravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in ThicknesyGauge/ASTM Sched Steel Plastic Stainless Steel Other No Casing <br /> Grout Seal Depth_)Op ft Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other 100'-3'NEAT CEMENT <br /> Grout Placement Method Pumped Free Fall Other 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 ft Standing Water Level ft <br /> 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL(209)953-7697 <br /> SIGNED �� -� TITLE Construction Manager DATE 09/06/202 <br /> VA <br /> r <br /> D <br /> 40 A <br /> o <br /> F O U Ty <br /> A <br /> T <br /> DEPARTMENT USE ONLY <br /> Application Accepted By �f� Date )D �n oaaj7 Area �9 Employee ID# �{t. <br /> Grout Inspection By *sl hob Date %\ I-1 (1j4!?n SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth 7�btj ft <br /> COMMENTS lay4-ov..0 5etx, ybe' �.1 `�S? d1� <br /> 3' b F�NJ <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes InfoB Cash Remitted Service Re uest# <br /> 371 IN a-- *3as' <br /> EHD43-06 6111/2019 /� _ r� 2) 7 WELL/PUMP PERMIT <br />