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i <br />MM(_ /10- 1 /yC 6kaflocI cur. «rn <br />RECEIVED <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 46 MAY <br />/ 9 2018 <br />NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />I L <br />W Y 't A Mantec CA 95337 <br />JOBADDRESS OSeml a venue CITY/ZIP ar F.NVtR(1NA �1VTAL HEAL? -H <br />CROSS STREET Swanson Road APN In Swanson Road PARCEL SIZE LAND USE APPLICATION IIEF 11TINIENT <br />OWNER NAME City of Manteca <br />OWNER ADDRESS IOD `yVe_&t• if_&-� e Jl.. <br />CONTRACTOR BSK Associates <br />PHO�NE�Q ('/� /y� �7K ;( �, 1y <br />CITY/STATE/ZIP � `�•, ���GO, CR 5,33 /% l <br />PHONE cn J -31,45- <br />V 1 � — �I 5 / <br />CONTRACTOR ADDRESS 399 Lindbergh Ave. CITY/STATE/ZIP Livermore, CA 94551 <br />SUBCONTRACTOR Exploration GeoServices Inc. PHONE 408-483-9026 <br />SUBCONTRACTOR ADDRESS 1535 Industrial Ave. CITY/STATE/ZIP San Jose, CA 95112 <br />LICENSE X C-57 C-61 D-09 Other NUMBER 484288 EXPIRATION DATE 12/31/19 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />NTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring Soil 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 Soil Boring(s) # of borings X Geotechnical 3 # of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />New Pump Pump Replacement Pump Repair Raise Well Casino <br />Drilling Method Mud Rotary i Air Rotary X Auger Cable Tool Push Point I Other <br />Proposed Well Depth 40 ft Excavation 8 in diameter Open Bottom Gravel Pack/Gravel 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 ft )A eat Cement (94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br />Bentonite (20 Solids) xO�t er Bore hole will be backfilled with cement grout using tremie methods <br />Grout Placement Method X 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 Levelft <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 />INIMUM 48 H R DVANCE O E EQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED � TITLE Staff Engineer DATE 5/24/18 <br />See Attached Site Plan E===== ft <br />PA T M E N T U E N Y <br />Application Accepted By 7.901 64fArl 44Date Area'?1�mployee ID# j� <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 />EHD 43-06 revised 4/14/18 WELL /PUMP PERMIT <br />