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f <br />WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDAB E PERMIT_ www.sigov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br />Joe ADDREss .��� CCITY/ZIPCITY/ZIP1P Ripon / 95366 <br />��yw <br />CROSS STREET / • � e, I V1 st APIN �/� O' PARCEL SIZE _r31 ri _LAND USE APPLICATION # 3263-42 <br />OWNER NAME Union Pacific Railroad (UPRR) PHONE (402) 544-8586 <br />OWNER ADDRESS 1400 Douglas St. STOP 1690 CITY/STATE/ZIP Omaha / NE / 68179 <br />CONTRACTOR Crawford & Associates, Inc. <br />CONTRACTOR ADDRESS 1100 Corporate Way Suite 230 <br />SUBCONTRACTORICONSULTANT Geo -Ex Subsurface Exploration <br />704 North Adams Street <br />PHONE (916)455-4225 <br />CITY/STATEOP Sacramento / CA / 95632 <br />PHONE (916)799-8198 <br />SUBCONTRACTORICONSULTANT ADDRESS CITY/STATE21P Dixon / CA 195620 <br />LICENSE VC -57 C-61 D-09 Other NUMBER 954267 ExPIRAnON DATE 7/31/2022 <br />BILLING PARTY: OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring VSoil Sampling/Characterization <br />Public Water System <br />If different from Owner. Water System Name Contact Name or Phone Number <br />TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br />Monitoring Well(s) # of wells VSoil Boring(s) 12 If of borings \/Geotechnical 12 If of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />New rump rump Replacement rump nepalr rake wen Lasing <br />WELL CONSTRUCTION <br />Drilling Method VMud Rotary Air Rotary VAuger Cable Tool Push Point Other <br />Proposed Well Depth 15-80 ft Excavation 4--8„ in diameter Open Bottom Gravel PacIdGravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth full depth ft VNeat Cement (94 lb bag/5-10 gat water) Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method VPumped VFree Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length ft Thick in Christy Box Stove Pipe <br />PUMP Submersible Turbine Other HP Pump Set ft 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 />MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED // -44-'0, .fir TITLE Staff Engineer DATE 9/29/21 <br />DEPARTMENT USE ONLY <br />Application Accepted By ��%2 ) Date 1D Area 1Zt Dr Employee I D# AG <br />Grout Inspection By Date SPECIAL Well Permit <br />Pump Inspection By DateWAIVER <br />1/7-11 <br />. WAIVER Received <br />Soil Borinq Inspection By Qatel / /"1 vr#onstructed Well Depth ft <br />EHD4346 611112019 � U --?� )32153// / ) WELL/PUMP PERMIT <br />