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WELUPUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JoeAoDREBS 10150 N L 1 `t _ CrTY/ZIP Stockton <br /> CROSS STREET Balsam Drive APN 08607036 PARCEL SIZE;,-,'> LANo USE APPLICATION# ! <br /> OWNER NAME Maher El Louhaiby PHONE 1-209-352-5789 <br /> __.._._._____....._.....__.._...._.... <br /> OWNERAooREss _302 W Beniamin Holt Drive CrrY/STATE2IP Stockton/CA/95207 <br /> CONTRACTOR MTR Drilling ...__ PHONE 1-916_813-02.53 <br /> CONTRACTOR ADDRESS 10 Main Ave, Ste 6 CITY/STATVZIP Sacramento/CA/95838 <br /> SUBCONTRACTOR _ N/A PHONE <br /> SUBCONTRACTOR ADDRESS C TY/STATEIZJP <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 905267 _ EXPIRATIONDATE 09/30/2017 <br /> GEOGRAPHICAL INFORMATION: Coordinates X_38 2'489408"N y 121 15'27.5616"W _ T2N RTE g6 — W <br /> Townahlp Range_.. __ Seaton,,__ <br /> INTENDED USE X Domestic/Private IrrigationiAgricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br /> Public Water System <br /> it diHerwq nom Owner Water em Nam U.Nact Nam nr ia uinTirr"-- <br /> TYPE OF WORK rXTJew Well Replacement Well Well AtlerationlModirication Other <br /> MonitoringWells #of Wefts Soil Bore r or bonngs S or botirw <br /> ( ) n9(a) Geotechnical__ __ <br /> Out-Of-Service Well Out-Of-Service Weil Renewal Cross-Connection Repair <br /> X New_Pump Pump Replacement Pump Repair Raise Weil Casing <br /> WELL CONSTRUCTION <br /> Drilling Method X Mud Rotary Air Rotary Auger Cable Toot Push Point Other <br /> Proposed Well Depth 150 it Excavation in diameter Open Bottom X Gravel PacklGravel Size 12 in diameter <br /> Conductor Casing "in diameter I Conductor Casing Depth <br /> Welf Casing Diameter 6 in Thickness/Gauge/ASTM Sched SDR-21 Steel X Plastic Stainless Steel Other _ <br /> Grout Seal Depth 100 ft .,<,Neat Cement(94 Ib twgrp$-IO gal water) Sand Cement" sank mixl7 gal Water <br /> Bentonile(20%solids) Other <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL Installed By X Driller Pump Contractor Other <br /> X Concrete Pedestal Dimensions:Width4 112' ft length 6' ft Thick 5 in Christy Box Stove Pipe <br /> X Submersil3le Turbine Other—__...._- HP 1 112 _ Pump Set 135 _it_Standing Water Level_ 70 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 /> MINIMUM124 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> xx <br /> Technical Engineer 06/21/2016 <br /> SIGNEO............ .(..'j:.:..�..,.,...:.__ ......... TfTLE..._......_....__.'-__..............._. ... ............. Uj <br /> DATE.............. <br /> LU <br /> ex 0% <br /> i <br /> .. C'J ULU = as <br /> r'�1 ZOW <br /> CV C3� <br /> CC <br /> W0 <br /> s ~a <br /> __III ( llilllllllllfl ( ( It � ( ( ( itlll _1_lllil <br /> DEPARTMENT USE ONLY i <br /> Application Accepted By_ Date i -2 (c� Area__,;;. t Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring I Date Constructed Well Depth_, h <br /> COMMENTS�, <br /> PE SC Received Check#/ Amount date Permit/ Invoice# Well ID# <br /> Cod"CodInfo B IJ% ash Remitted Service Request# <br /> b C7 7S <br /> S <br /> EH043.00 WELL 1PUMP PERMIT <br /> 4/30112 <br />