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r <br /> WELUPUMP PERMIT <br /> SAN JOAQUDf CoW/TY ENNRoN;dENTAL HEAL TR DEPARTMENT 1868 EAST HAZELToN AVENUE-STOCKTON CA 88205.6232(209)468J420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> N <br /> JOB ADDRESS 21225.51nc2ir Avenue CrTYILP Stockton.95215 <br /> D <br /> Fa mu;glon Rd 171150.160/173150.190 1150 <br /> CROSS STREET APN PARCELS-- !arm UsE A►rUCAigNQ_` <br /> OWNER NAME S.XW Pa V"LLC PHONE w <br /> OWNER ADDRESS PO ftx 60607 C1TYfSTATEIZtP Palo AMS,CA 943W <br /> CONTRACTOR Comerstone Earth Group PHONE 408.245-46W <br /> CONTRACTOR ADDRESS 1259 pnkrnead PaNMwey CMISTAWJZ11 Sunnyvale.CA,94085 <br /> SUaCONTRACTORICONSULTANT Explorabun Gm r%oas.tw PHONE 4062806822 <br /> SUBCONTRACTORICONaULTANT ADOREsti 15351ndusnial Avenua Crry/STATE2D San Jose,CA,95112 <br /> LICENSE X C-57 I I C-61 i I D-09 I I Other NUMBER 484268 EXPIRATION DATE 12!312021 <br /> BO.IINO PARTY: :1 OWNER t:CONTRAGToit :t SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING:H General Mineraf/Coliform Badena(439 1)i I Dibromodtloropmpane(4392) Arsenic(4393) <br /> INTENDED USA 1 I DomesOdPrivale 1 I Ir 811ordAgnculWral 1:Industrial !1 Witter Quality Monitoring 1!Soil Sampling/Characterization <br /> I I Public water System <br /> IrdCa—d nom Owner Woe,sritam N— Con4C1 Isms or Phone NurMtr <br /> TY►E Of WORK I New WeU Reptacemenl WeU :.WellAlteration/Moddka0on Other <br /> MonitoringWeU(s) Bol wells XSoilBanngIs) aorixxugr XGeoledtnlral6 sorboty% <br /> Out-Of-Service Well Out-Of-SeNce Mg Renewal ; Cross-Conrtecbon Repair <br /> New Pump I;Pump Replacement Pump Ra a'U 1:Raise Well Cash <br /> WELL CCMSTRUCTION <br /> Drilling Method I I Mud Rotary I 1 Air Rotary X Auger i Cabte Tool 1,Push Point Other <br /> Proposed WOU Depth 35 R Excavation 8 In diameter I Open Bottom ,Gravel PadJGrevd Size In diameter <br /> :Conductor Casing in diameter / Conductor Casing Depth R <br /> Well Casing Dlameler_in Thkkness/Gauge/ASTM Sched ' Sleet is Flaslk i Stainless Steel ..Other <br /> Grout Seal Depth 3S it )(Noel Cement(94 1b bevy-10 gel wafer) 1;Send Cement sank m1xf7 gal water <br /> I Benlonite(20%solids) 1 I Other <br /> Grout Placement Method it Pumped 1 I Free Fell X Other trmnie I I Retardant/Accelerator(name) <br /> PEDESTAL Installed By P Drtam II Pump Contrador Other <br /> Concrete Pedestal I Dimensions:V'Adth D Length It Thick in :Christ Box r]Stow Plpe <br /> ::Submemlie'Ll Turbine ..Other RP Pump Set R Standing Water Level 11 <br /> I "E..'CERTIFY TNA I NAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQLAN COUNTY O LACES ATE LAWS,AND RULES AND REGULATIONS, 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT D A E ALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WORKERS ON S, <br /> MINIM 48 VANCE NOTICE REQUIRED Fj R NSPECTIONS-PLEASE CALL(209)95 -76 L7 <br /> SICKED TITLE DATE L <br /> F FLAT <br /> LQ 144, <br /> SFO <br /> �N C <br /> qR MENTr <br /> J <br /> DEPARTMENT USE N L Y <br /> Application Accepted By G Dole ,p� 0 Area S �r Employee IDN_DA4_ i <br /> Grout Inspection By ,e Date !I SPECIAL Well Permit - <br /> Pump Inspedlon By Date WAIVER Rece(ved <br /> Soil Boring Inspection By Date Constructed Well Depth It <br /> COMMENTS <br /> PE SC Received CReckW Amount Date PennlU Invokes Well[Do <br /> Codes Into Cafe Remlttod Servl o R uest <br /> 1 <br /> E.D4)O6 6111gDle WELL'PUMP PERMIT <br />