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C )CMEST1C WELL SAMPLING: General Pdineral/Coliform Bacteria (4391) Dibromochloropropane (4392) - Arsenic (4393) yTENDED UsE ✓ DomesticJPrivate ["'rrigation/Agricultural ndustrial Water Quality Monitoring Soil Sampling/Characterizalion Public Water System Irdi#.rent from Ovmor. Walar System Name Contact Name or Phone Number YPE OF WORK I,—/]NewWell Replacement Well _ Well Alteration/Modification U Other Monitonng Well(s) # of wells oil Boring(s) N °I bO-gs Geotechnical a o1 "0113' .- Out -Of -Service Well - Out -Of -Service Well Renewal -- Cross -Connection Repair New Puma I Pump Reolacemenl -- Pumu Repair - Raise Well Casino WELL CONSTRUCTION Drilling Method ✓Ovlud Rotary a4ir Rotary - Auger --: Cable Tool : Push Point n Other Proposed Well Depth 201 R Fxcavatinn 10 in diameter Open Rottorn ravel Pack/Gravel Size n/a in diameter Conductor Casing in diameter / Conduclor Casing Depth ft Well Casing Diameter _ in Thickness/Gauge/ASTM Sched Sch 40 E]Steel - Plastic Stainless Steel 13ther Grout Seal Depth 100 It QNeat Cement (94 /b Lay/5-10 gal Ivaler) - Sand Cement sack mix/7 gal water Bentonite (,20 % solids) _ Other Grout Placement Method[ " ipumped -� Free Fall Other Retardant / Accelerator (name) rLEDESTAL Installed By Driller 2Pump Contractor LILJ Other M'--1 -I Concrete Pedestal _I Dimensions: Width_ ft Length ft Thick in 1 Christy Box -. Stove Pipe PUMP Submersible _. Turbine _ Other HP Pump Set It Standing Water Levelft 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINAN STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE W THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LPy S. MINIMUM 8 H/Ol1R ADVCE7JOJ71C REQUIRED FO NSPEC ON PLEASE CALL (209) 953-7697 7 SIGNED / C `- TIT //,%/ �C%�/%/ �/G'DATE -� ��YJ Application Accepted By Grout Inspection By Pump Inspection By Soil Boning In pedlar, By COMMENTS ZPA TMENT USJ OPIL�1( Dale �/Jl Date Dale 13 �P-at7)V 0 M�COU '�RTM HT Area Employee ID# D PECIAL Well Permit p WAIVER Received 111 Co sl cted Well DepthED PE Sc Received Check#/ Amount Permit/ Codes Info B ash emitted Date Service Re uest# Invoice # ell ID# i EHD 43-C6 r,tie d 4114118 OD 1 WELL /PUMP PERMIT ✓ �p-I✓�, i O�VI U ("6 7921 WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS on West side of North F St (88 ft south off Waterloo Rd.) CITY/ZIP Stockton, 95205 CROSS STREET Walerinn Rd APN PARCEL SIZE LAND USE APPLICATION # OWNER NAME county right of way PHONE 209-468-3.720 OWNER ADDRESS CITY/STATE/ZIP CONTRACTOR Farwest Corrosion Control -'All Work Is Done For PG&E / PM# 31373236PHONE 510-925-9256 CONTRACTOR ADDRESS 2223 Commerce Place CITY/STATE/ZIP Hay;rard CA 94545 SUBCONTRACTOR PHONE SUBCONTRACTOR ADDRESS CITY/STATE/ZIP -(CENSE ZC-57 ❑C-61 F -ID -09 nOther NUI.IBER 248232 EXPIRATION DATE 17!31/2019 )CMEST1C WELL SAMPLING: General Pdineral/Coliform Bacteria (4391) Dibromochloropropane (4392) - Arsenic (4393) yTENDED UsE ✓ DomesticJPrivate ["'rrigation/Agricultural ndustrial Water Quality Monitoring Soil Sampling/Characterizalion Public Water System Irdi#.rent from Ovmor. Walar System Name Contact Name or Phone Number YPE OF WORK I,—/]NewWell Replacement Well _ Well Alteration/Modification U Other Monitonng Well(s) # of wells oil Boring(s) N °I bO-gs Geotechnical a o1 "0113' .- Out -Of -Service Well - Out -Of -Service Well Renewal -- Cross -Connection Repair New Puma I Pump Reolacemenl -- Pumu Repair - Raise Well Casino WELL CONSTRUCTION Drilling Method ✓Ovlud Rotary a4ir Rotary - Auger --: Cable Tool : Push Point n Other Proposed Well Depth 201 R Fxcavatinn 10 in diameter Open Rottorn ravel Pack/Gravel Size n/a in diameter Conductor Casing in diameter / Conduclor Casing Depth ft Well Casing Diameter _ in Thickness/Gauge/ASTM Sched Sch 40 E]Steel - Plastic Stainless Steel 13ther Grout Seal Depth 100 It QNeat Cement (94 /b Lay/5-10 gal Ivaler) - Sand Cement sack mix/7 gal water Bentonite (,20 % solids) _ Other Grout Placement Method[ " ipumped -� Free Fall Other Retardant / Accelerator (name) rLEDESTAL Installed By Driller 2Pump Contractor LILJ Other M'--1 -I Concrete Pedestal _I Dimensions: Width_ ft Length ft Thick in 1 Christy Box -. Stove Pipe PUMP Submersible _. Turbine _ Other HP Pump Set It Standing Water Levelft 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINAN STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE W THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LPy S. MINIMUM 8 H/Ol1R ADVCE7JOJ71C REQUIRED FO NSPEC ON PLEASE CALL (209) 953-7697 7 SIGNED / C `- TIT //,%/ �C%�/%/ �/G'DATE -� ��YJ Application Accepted By Grout Inspection By Pump Inspection By Soil Boning In pedlar, By COMMENTS ZPA TMENT USJ OPIL�1( Dale �/Jl Date Dale 13 �P-at7)V 0 M�COU '�RTM HT Area Employee ID# D PECIAL Well Permit p WAIVER Received 111 Co sl cted Well DepthED PE Sc Received Check#/ Amount Permit/ Codes Info B ash emitted Date Service Re uest# Invoice # ell ID# i EHD 43-C6 r,tie d 4114118 OD 1 WELL /PUMP PERMIT ✓ �p-I✓�, i O�VI U ("6 7921