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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 1 YEAR FROM DATE ISSUED <br /> y <br /> JOB ADDRESS 30100 S Airport WY Manteca,CA 95337 cm/zip Manteca/95337 m <br /> s <br /> CROSS STREET 2 Rivers Road APN 25707020 PARCELSIZE281.4 aCLAND USE APPLICATION# TEP Attached 8 <br /> OWNER NAME Dirk McManis PHONE (209)456-1631 H <br /> OWNER ADDRESS 18700 East River Road CtrnSTATEMP Ripon/CA/95366 _o <br /> O <br /> 15011 RAC I ORO <br /> onsultant: AECOM Technical Services,Inc PHONE 916-679-2000 <br /> U) <br /> aEss 2020 L Street,Suite 400 cnY/STATMP Sacramento/CA/95811 n <br /> SUBCONTRACTOR Geo-EX Subsurface Exploration PHONE 916-799-8198 <br /> SUBCONTRACTOR ADDRESS 1510 Madera Dr Cm/STATE/zip Dixon/CA/95620 <br /> Iv <br /> LICENSE x C-57 C-61 D-09 Other NUMBER 954267 EXPIRATION DATE 07/31/2020 N <br /> n <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> n <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring x Soil Sampling/Characterization D <br /> Public Water System w <br /> If different from Owner Water System Name Contact Name or Phone Number <br /> 4 <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br /> Monitoring Wells) #of wells Soil Boring(s) #of borings x Geotechnical 18 #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 45-60 It 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 Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Depth ft x Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 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 it Length It Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set It 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 COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED -�S ^� TITLE President DATE t <br /> ATTkCHZD FQE imniad <br /> NT <br /> ED <br /> AOUIN <br /> 018 <br /> UNTy <br /> N AL <br /> ENT <br /> TMENT UE ONLY <br /> Application Accepted BytW'xL4* Date lJ �, V Area Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By c Date 2 Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Permit/ <br /> Codes Info B Cash emitted Date a Ice Request# Invoice# Well ID# <br /> 2 <br /> EHD 4108 ",sed,t/14/18 WELL/PUMP PERMIT <br />