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WELLIPUMP PERMIT <br /> SAN JOAQL;N COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1608 EAST HAZELTON AYENUE•STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT vvwwsjgov.aM/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Jos ADDRESS 2222 S.Sinclair Avenue -` CITYIZ[P Stockton.95215 _,-- <br /> n <br /> Farmington Rd 173.1 50-1 60 11 7 3.150-190 11.50 0 <br /> CROSS STREET APN PARCEL SrrF LAND USE APPLICATION O_- O <br /> m <br /> OWNER NAME S,ncjair Partmrs LLC _v PHONE <br /> OWNER ADDRE33 PO Box 60607 J--_ CrTYISTATEIZIP Palo Aft .CA.94306 <br /> CONTRACTOR Cemcatone Earth Group _- _ PHONE 408-245-4600 <br /> CONTRACTOR ADDRESS 12590akmead Parkway _ CrTYISTATEMP Sunnyvelo.CA,94085 <br /> SVBCONTRACTORICONSULTANT F_xp`.craaon Goosom es.Inc _ _ PHONE 4(18280-M2 <br /> SUBCONTRACTORICONSULTANT AVE)REe8 1535 Industrial Avenuo CITYISTATPJZW San.lose,CA-95112 <br /> LICENSE X C-57 I I C-81 I I D-09 11 Other NUMBER 484288 EXPIRATION DATE 1213112021 <br /> BU—INO PARTY: .)OWNER "CONTRACTC11 :I SUBCON iRACTORICONSULTANt <br /> DOMESTIC WELL SAMPLING:I)General Mir erallColifornl Bacteria(4391)i I Dibromochloropropane(4392).:Arsenic(4393) <br /> INTEN13po USF I I Domestic/Private (I Intgation/Agdcultural I Industrial P Water Quality tdenitering :!Sail Sampling/Characterization <br /> I I Public Water System <br /> EI ddeorcrl nom Ramer VMI'Sym—Name COntau Name ar Phone NumDe� <br /> ME OF WORK I Nev Well :I Reptacemeirl Well : WelI Alterationhhodification i Other <br /> Monitoring We{I(s) 0 of wells X Sail Boring(s) a Or t>vn"pa X Geotechnical 6 _ - r Or bcn4r <br /> Out-Of-Service Weil Cut-Of-Service Well Renewal C(oss-Connection Repair <br /> !Now Pump f;Pump Replacement Pump Repair I!Raisa Well Casing _ <br /> WELL CONSTRUCTION <br /> Drilling Method I I Mud Rotary !I AG Rotary k Auger Cable Tool I!push point :1 011ier <br /> Proposed Well Depth 35 It Excavation 8 in diameter I Open Bottom I Gravel Pack/Gruvel Slzo _In diameter, <br /> :Conductor Casing in diameter I Conductor Casing Depth R <br /> Wap Casing Olameler _in ThicknessfGaugeIASTM Shed Steel ii Plastic I I Stainless Steel .. Other <br /> Grout Seal Depth 35' h )(Neal Cement(94 lb bagrSfO gal wataQ r I Sand Cement sack mrxf7 gal water <br /> I Banlonito(2096 solids) I I Other <br /> OroutPlacementMethod lI Pumped II Free Fail X Other tremie II Retardant IAcceleralor(name) <br /> JPFOESTAL Installed By I'Driller I Pump Contractor Other <br /> :Concrete Pedestal I:Dimensions:Width R Length it Thick in :Christy Box r)Stove Pipe <br /> PUMP ::Submersibletl Turbine "Other HP Pump Set ft Standing Water Level It <br /> 1 HEREBY CERTIFY THA I tVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY OR MINCES TATE LAWS, AND RULES AND REGULATIONS, 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT DA V WIT E ALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS C N A ON S. I <br /> h71NIM 48 VANCE NOTICE REQUIRED F R INSPECTIONS-PLEASE CALL(209)®95 -76 7 <br /> SIGNED TITLE DATE L <br /> q �'M <br /> ?8z o <br /> TJ <br /> DEPARTMENT USE N L Y 1 <br /> Application Accepted By � re <br /> Date �0 a��,tp Aa' s�ae� r Employee IDaD_ <br /> Grout Inspection By- V we i l " Co. <br /> SPECIAL Well Permit <br /> Pump Inspection By Dalo— WAIVER Received <br /> Sail Boring inspection By Date Conatrucled Well Depth ft <br /> COMMENTS <br /> PE SC Received Chec)Lw Amount Oate PormlV Invoked Well(00Codes Info Cts Remitted Servi e R uest <br /> ill 7 <br /> ERDc1106 a/IMID WELL(PUMP PERUIT <br />