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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 CALL 209 953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED <br /> JOBADDRESS 5700 E.Nile Road CITY/ZIP Manteca,CA 95337 m <br /> a <br /> CROSS STREET Union Road APN 22607003 PARCEL SIZE 15.3 LAND USE APPLICATION# o <br /> m <br /> OWNER NAME Manteca Unified School District-Contact:Justin Geer,Constr./Energy Tech. PHONE Cell:209.456.0295 H <br /> OWNER ADDRESS 2271 W.Louise Avenue(Mailing:P.O.Box 32) CITYISTATEIZIP Manteca,CA 95337 <br /> O <br /> V&W Drilling Inc. -Contact:Karli Stroin Cell:209.981.7755 0 <br /> CONTRACTOR g g PHONE r77 <br /> CONTRACTOR ADDRESS 1133 Blackhurst Drive CITY/STATE/ZIP Galt,CA 95632 z <br /> SUBCONTRACTOR PHONE O <br /> w <br /> n <br /> SUBCONTRACTOR ADDRESS CITYISTATE/ZIP <br /> w <br /> LICENSE X C-57 C-61 :_D-09 Other NUMBER 720904 EXPIRATION DATE 04/30/2020 <br /> n <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391)-Dibromochloropropane(4392) 1 Arsenic(4393) ° <br /> n <br /> INTENDED U Domestic/Private i I Irrigation/Agricultural i Industrial Water Quality Monitoring i Soil Sampling/Characterization a r <br /> Public Water System I J <br /> If different from Owner: Water System Name Contact Name or Phone Number f <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> y7 <br /> Monitoring Wells) #of wells Soil Boring(s) #of borings X Geotechnical 5 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal . Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method X Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br /> Proposed Well Depth 5 to 50 it Excavation 4 1/2 in diameter i Open Bottom 1 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 I Plastic 1 Stainless Steel Other <br /> Grout Seal Depth full depth ft *X Neat Cement(94 lb bag/5-10 gal water) 1 Sand Cement sac l)mixl7 gal water <br /> `.212910 Erle(20%solids) Other <br /> Grout Placement Method Pumped Free Fall Other - Retardant/Accelerator(name) 21 <br /> PEDESTAL Installed By Driller Pump Contractor - Other <br /> Concrete Pedestal Dimensions:Width ft Length It Thick in _ Christy Box Stove Pipe <br /> Pu MP 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 CO ATION LAWS. <br /> MINI M 4 O R ANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED CA PE GE 42295 TITLEVice President,Engineering Services DATE 10/26/18 <br /> DP RN <br /> TMENT USE ONLY Application <br /> Application Accepted By Date Area Employee ID# A r ' <br /> Grout Inspection By Date I SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By 44)66 ` Date Constructed Well Depth ft <br /> COMMENTS ogyMENT <br /> PE SC Received Check#/ Permit/ CEIVE® <br /> Codes Info Cash Aaemittedl Date S ice R?,guest# Invoice# Well ID# <br /> ° 0 2 2018 <br /> AQUIN COUNTY <br /> r-KWIRONMENTAL <br /> DEPARTMENT <br /> EHD 43-06 revised 4/14/18 WELL rPUMP PERMIT <br />