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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 wvvW.sjgov.org1ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOBADDRESS 38.021040°.Log:-121.363676° CITYrzIPStockton,CA.95206 <br /> a <br /> CROSSSTREET Mariners Dr/Hammer Ln APN071-260-140 PARCELSIZE 11.0 LAND USE APPLICATION# Unknown p <br /> m <br /> OWNER NAME Tom McKean (Representative) P,RE/} m��bWa�t¢r Yr'{'C)r✓t �qUA Q NE(209)957-5707 w p� <br /> OWNER ADDRESS 8035 Mariners Drive PO &yam A 19'7 Q CIN/STATE/21P Stockton CA 95219 rzhiicO'jx 666 `6 <br /> CONTRACTOR Gregg Drilling,LLC PHONE (925)313-5800 <br /> CONTRACTOR ADDRESS 950 Howe Road CITY/STATE/ZIP Martinez,CA 94553 <br /> SUBCONTRACTOR/CONSULTANT Kleinfelder,Inc PHONE (209)993-2269 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 2001 Arch Airport Rd,Suite 100 CIN/STATE/ZIP Stockton,CA 95206 <br /> LICENSE E C-57 D C-61 D D-09 D Other NUMBER 1044456 EXPIRATION DATE 09/30/2022 <br /> BILLING PARTY: D OWNER D CONTRACTOR 0 SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:❑General Mineral/Coliform Bacteria(4391)❑Dibromochloropropane(4392)E:Arsenic(4393) <br /> INTENDED USE D Domestic/Private D Irrigation/Agricultural D Industrial C Water Quality Monitoring E Soil Sampling/Characterization <br /> D Public Water System <br /> N different From Owner: Water System Name Contact Name or Phone Number <br /> TYPE OF WORK D New Well D Replacement Well D Well Alteration/Modification 0 Other <br /> 0 Monitoring Well(s) #of wells 0 Soil Boring(S) x of borings N Geotechnical one(1) If of borings <br /> 0 Out-Of-Service Well 0 Out-Of-Service Well Renewal D Cross-Connection Repair <br /> D New Pump D Pump Replacement D Pump Repair D Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method D Mud Rotary D Air Rotary - Auger D Cable Tool D Push Point 0 Other <br /> Proposed Well Depth 45 It Excavation 8 in diameter D Open Bottom - Gravel Pack/Gravel Size in diameter <br /> D Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched D Steel D Plastic D Stainless Steel 0 Other <br /> Grout Seal Depth 45 It E Neat Cement(94 Ib bag/5-10 gal water) D Sand Cement sack mix17 gal water <br /> Bentonite(20%solids) E Other u0 to 5%bentonite <br /> Grout Placement Method 0 Pumped D Free Fall E Other Tremie Full-Depth D Retardant/Accelerator(name) <br /> PEDESTAL installed By 0 Driller D Pump Contractor 7 Other <br /> D Concrete Pedestal❑Dimensions:Width ft Length ft Thick in D Christy Box D Stove Pipe <br /> PUMP 0 Submersible'D Turbine D Other HP Pump Set it Standing Water Level ft <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 /> MI M 8UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Onerations Manager DATE 11/30/2021 <br /> R'�YM <br /> �cFj�NT <br /> DFS �8 FO <br /> o <br /> SEE ATTACHED BORING LOCATION MAP yFq T/,?Q�A/Coo MFiNT), <br /> I / DEPARTMENT USE ONLY 1 j <br /> Application Accepted By CTS L /✓ Date rl/ Area 3 S!a'�`�3l(Employee ID# / <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Check#/ Amount D Permit/ Invoice# WeIIID# <br /> Codes Info Cas Remeitted Service Re ues # <br /> 417-1 o s6 0 <br /> EHD 43-06 6/1112019 . �/���n�J�� WELL/PUMP PERMIT <br />