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S <br />r ' WELL/PUMP 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 t_AVIKi T YEAR FROM LATE ISSUED <br />JOB ADDRESS 5298 Brunswick Road <br />CITY/LP Manteca, CA <br />CROSS STREET 99 Frontage APN (01- <br />i2b PARCELSME LAND USE APPLICATION# <br />OWNER NAME San Joaquin Delta Community College <br />PHONE 209-954-5151 <br />OWNER ADDRESS 5151 Pacific Avenue <br />CITY/STATE/LP Stockton, CA 95207 <br />CONTRACTOR Krazan & Associates, Inc. <br />PHONE 559.348.2200 <br />CONTRACTOR ADDRESS 215 W. Dakota Avenue <br />SUBCONTRACTOR Krazan & Associates, Inc. <br />SUBCONTRACTOR ADDRESS 215 W. Dakota Avenue <br />LICENSE /C-57 r1 C-61 I D-09 Other <br />CITY/STATEIZIP Clovis, California 93612 <br />PHONE 559.348.2200 <br />CITY/STATE/ZIP Clovis. California 93612 <br />NUMBER 499908 EXPIRATION DATE 10.31 .2020 <br />DOMESTIC WELL SAMPLING: n General Mineral/Coliform Bacteria (4391) J Dibromochloropropane (4392) C Arsenic (4393) <br />INTENDED USE , I Domestic/Private a Irrigation/Agricultural ' I Industrial t] Water Quality Monitoring rI Soil Sampling/Characterization <br />t I Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK I New Well I'. Replacement Well I : Well Alteration/Modification i Other <br />i Monitoring Wells) # of wells r Soil Bonng(s) # or borings Geotechnical 12 # of borings <br />Out -Of -Service Well t: Out -Of -Service Well Renewal Cross -Connection Repair (10-50 Feet) <br />New Pump IPump Replacement r Pump Repair Raise Well Casing <br />Drilling Method Mud Rotary i Air Rotary ./ Auger Cable Tool r Push Point Other <br />Proposed Well Depth ft Excavation in diameter I' Open Bottom ' I Gravel Pack/Gravel Size in diameter <br />I I Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter _ in Thickness/Gauge/ASTM Sched LI Steel i Plastic I I Stainless Steel I Other <br />Grout Seal Depth ft ./ Neat Cement (94 Ib bag/5-10 gal water) I Sand Cement sack mix/7 gal water <br />I I Bentonite (20% solids) ! ! Other <br />Grout Placement Method Pumped I Free Fall i Other Retardant / Accelerator (name) <br />PEDESTAL Installed By : Driller Pump Contractor Other <br />Concrete Pedestal ::Dimensions: Width ft Length fl Thick in Christy Box Stove Pipe <br />Pump -:1 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. 1 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 />SIGNED <br />MINIMUM 48 HOU ANC N TICE RE91UKD FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />LTITLE Managing Engineer DATE 03/08/2019 <br />EP <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />TIM ENT U E JONLY <br />—Bate / ( A <br />D79 <br />ate AJA <br />Date <br />Date <br />MENT <br />EIVED <br />1 1 2019 <br />N COUNTY <br />MENTAL <br />:'ARTMENT <br />Area Employee ID#%� <br />F1 SPECIAL Well Permit <br />I WAIVER Received <br />Constructed Well Depth ft <br />EHD 43-08 revised 4/14/18 WELL /PUMP PERMIT <br />