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WELL/PUMP PERMIT <br /> SAN JIOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAIELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> �J N <br /> JOB ADDRESS aWPI c ,m„�,P.rs -- CITY/LP '1f C-IL rq S17- m <br /> S.Lammers Road 251050090 and o <br /> CROSS STREET APN_251-050-080 _ PARCEL SIZE 6e LAND USE APPLICATION# z <br /> OWNER NAME Intearal Partners Fundina. LLC PHONE 209-239-8400 N <br /> OWNER ADDRESS 1001 West Center Street CRY/STATFIZIP_Tracy,CA 95377 <br /> CONTRACTOR ENGEO Incorporated PHONE 562-472-4358 <br /> CONTRACTOR ADDRESS 17278 Golden Valley Parkway CRYISTATEIZIP Lathrop,CA 95330 <br /> SUBCONTRACTOR West Coast Exploration PHONE 916-799-8198 <br /> SUBCONTRACTOR ADDRESS 1396 BRIARWOOD AVE CIrY/STATTJZIP Escalon CA 95320 <br /> LICENSE ); .-' C-61 D-09 Other NUMBER 670761 EXPIRATION DATE 01-03-2022 <br /> IMP ;t <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domesbc/Privete Irrigation/Agricultural Industrial Water Quality Monitoring X Soil Sampling/Characterization <br /> Public Water System <br /> II different from Owner Water System Nemo Conrad Name or Phone Number <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Wells) #of wells Soil Boring(s) s of borings X Geotechnical 9 n 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 Mud Rotary Air Rotary Auger Cable Tool X Push Point Other <br /> Proposed Well Depth 25 It Excavation 4 inches in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter I Conductor Casing Depth h <br /> Well Casing Diameter_in Thickness/GaugelASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth a S It X Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix17 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width It Length It Thick in Christy Box Stave Pipe <br /> PUMP Submersible Turbine Other HP Pump Set ft 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 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> 61, <br /> t i <br /> 0iT <br /> C t D <br /> 021 <br /> %N,OA U1 C UtLITY, <br /> EA THiEF kR1IIIENT <br /> j <br /> DEPARTMENTUSEONLY <br /> Application Accepted By 'I'— Date Area S "C Employee I._A s <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By. ,P ate Constructed W I Depth H, <br /> COMMENTS 1F 1N f_ �' %i- alJU�'IC lA� pl' )C F+H/.. l/i'1t?1 LO "tt ttJb <br /> a�yC,a�9 s w W t t t V t-tJ�1 kZt 3 <br /> PE SCReceive Check#I Amount Data Permit/ Invoice# Well <br /> Codes In Cash Remitted a ce R s # <br /> 37a 150 4 167a <br /> ENO 43-06 reWsad 4!14118 , 1 3 d s5"I $1 /'V WELL/PUMP PERMIT <br />