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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-9420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1601 Northgate Drive CIN/ZIP Manteca/95336 m <br /> CROSS STREET London Avenue qpN Z l7I(� ©� PARCEL SIZE LAND USE APPLICATION# o <br /> a <br /> OWNER NAME Manteca Unified School District-Contact:Justin Geer PHONE 209.858.0716 N <br /> OWNER ADDRESS 2271 W.Louise Avenue CITY/STATE17JP Manteca,CA 95337 o, <br /> _O <br /> CONTRACTOR V&W Drilling-Contact:Karli Stroing PHONE Cell:209.981.7755 z <br /> CONTRACTOR ADDRESS 1 133 Blackhurst Drive CITY/STATE/ZIP Galt,CA 95632 <br /> Oa <br /> w <br /> SUBCONTRACTOR PHONE � <br /> C7 <br /> SUBCONTRACTOR ADDRESS CITYISTATE/ZIP <br /> ro <br /> LICENSE X C-57 C-61 i D-09 Other NUMBER 720904 ExPIRATION DATE 04/30/2020 3 <br /> w <br /> DOMESTIC WELL SAMPLING:-General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> w <br /> INTENDED USE Domestic/Private Irrigation/Agricultural - Industrial :Water Quality Monitoring Soil Sampling/Characterization "n <br /> Public Water System y <br /> If different from Owner: Water System Name Contact Name or Phone Number �D <br /> w <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification -Other 01 <br /> rn <br /> Monitoring Well(s) #of wells I Soil Boring(s) #of borings X Geotechnical_ �j #of borings <br /> i Out-Of-Service Well -1 Out-Of-Service Well Renewal -1 Cross-Connection Repair <br /> I New Pump I Pump Replacement -1 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 10 to 50 ft Excavation 4 1/2 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 full depth ft X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mixl7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method i: Pumped Free Fall X Other Tremie Retardant/Accelerator(name) <br /> PEDESTAL Installed By 17 Driller Pump Contractor TOther <br /> Concrete Pedestal (Dimensions:Width ft Length fl Thick in 1 1 Christy Box -1 Stove Pipe <br /> PUMP 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 ENSATION LAWS- <br /> U U VANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED PE,GE#2295 TITLE Vice President,Engineering Services DATE 01/11/2019 <br /> R q�tii <br /> V <br /> zO <br /> 1114 Ir �9& <,O/,g <br /> FAM N00' <br /> SRT Tq� �Y <br /> MFtiT <br /> EP RTMENT USE ONLY �,rrr� <br /> Application Accepted By Date I n Area �F�Vmployee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date n 2 WAIVER Received <br /> Soil Boring Inspection By Date 2 319 Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check Amount Date PermlU Invoice# Well ID# <br /> Codes Info ash Remitted Service a st# <br /> EHD 43-06 re sed 4/14/18 WELL/PUMP PERMIT <br />