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t <br />REC <br />MAR <br />r'/ R <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT <br />CALL 209 953-7697 FOR INSPECTIONS <br />1EXPiR11:5 9 YEAR FROM UATE ISSUED <br />JOB ADDRESS 18499 Jack Tone Road <br />CITY/ZIP <br />Manteca, CA 95336 <br />CROSS STREET Santos Avenue <br />/J ^ <br />APN 2 e 0/1 PARCEL SIZ-F— <br />O AND USE APPLICATION # <br />Winters Farming Co. <br />� <br />(209) 534.3567 <br />OWNER NAME <br />IEL—.r- f <br />PHONE <br />OWNER ADDRESS 18499 Jack Tone Road <br />CITY/STATEIZIP <br />Manteca, CA 95336 <br />Krazan & Associates, Inc. <br />559'348'2200 <br />CONTRACTOR <br />PHONE <br />CONTRACTOR ADDRESS 215 W. Dakota Avenue <br />CITY/STATE/ZIP <br />Clovis, CA 93612 <br />IR ADDRESS CITYISTATEIZIP <br />C-57 I C-61 D-09 I:; Other NUMBER 499908 <br />PHONE <br />ExPIRATION DATE 10/31/2018 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township_ Range Section_ <br />WENDED USE DomestlC/Private ' Irrigation/Agricultural i'� Industrial Water Quality Monitoring -` Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water SySteol Name Contael Name or Phone Number <br />TYPE OF WORK New Well " Replacement Well Well Alteration/Modification Other <br />Monitoring Well(s) # of wells ::; Soil Boring(s) #ofbodngs Geotechnical 2 9 f borings <br />Out -Of -Service Well Out -Of -Service Well Renewal i Cross -Connection Repair (/ J5 —6-0 F4-) <br />Drilling Method Mud Rotary " Air Rotary Auger Cable Tool Push Point 7 Other <br />Proposed Well Depth 15-50 ft Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth - <br />ft <br />z <br />Well Casing Diameter 4 in Thickness/Gauge/ASTM Sched - Steel Plastic Stainless Steel Other <br />Grout Seal Depth ft / Neat Cement (94 lb bag/5-10 gal water) Sand Cement sack mixR gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method ;,' Pumped Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal :_:Dimensions: Width ft Length It Thick in Christy Box Stove 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 24R VVVAANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />Srrsucn ���•r % nTLE Managing Engineer DATE03/19/2018 <br />22 2018 <br />///V CO <br />MFNTUN7Y <br />At <br />�RTMe'Nr <br />Area-� Employee IAfr <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />PE Sc Received Check Amount Date Permit/ Invoice# WellID# <br />Codes Info B s Remitted Service Request # <br />LOP o0 3f 77 <br />EHD 43-08 <br />4130/12 <br />weu mumr remm� <br />PA TMENT U E N Y <br />Application Accepted By <br />Date l <br />Grout Inspection By <br />Date <br />Pump Inspection By <br />A, <br />Date <br />LO�g <br />Soil Boring Inspection By <br />Date <br />COMMENTS <br />22 2018 <br />///V CO <br />MFNTUN7Y <br />At <br />�RTMe'Nr <br />Area-� Employee IAfr <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />PE Sc Received Check Amount Date Permit/ Invoice# WellID# <br />Codes Info B s Remitted Service Request # <br />LOP o0 3f 77 <br />EHD 43-08 <br />4130/12 <br />weu mumr remm� <br />