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WELL/PUMP PERMIT <br /> z 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 /> r/1 <br /> JOBADDRESS 14600 Austin Road CITY/ZIP Manteca,CA 95336 m <br /> D <br /> CROSS STREET Lathrop Road ApN PARCEL SIZEAND USE APPLICATION# z <br /> m <br /> OWNER NAME Manteca Unified School District-Contact:Jeff McLarty,Constr./Energy Tech. PHONE 209.858.0758 uy,, <br /> OWNER ADDRESS 2271 W.Louise Avenue CITYISTATEIZIP Manteca,CA 95337 <br /> CONTRACTOR V&W Drilling-Contact:Karli Stroing PHONE Cell:209.981.7755 <br /> CONTRACTOR ADDRESS 1 133 Blackhurst Drive CITY/STATE/ZIP Galt,CA 95632 <br /> SUBCONTRACTOR PHONE <br /> SUBCONTRACTOR ADDRESS CITY/STATE/ZJP <br /> LICENSE X C-57 I C-61 LI D-09 I Other NUMBER 720904 EXPIRATION DATE 04/30/2020 <br /> DOMESTIC WELL SAMPLING: I General Mineral/Coliform Bacteria(4391)__Dibromochloropropane(4392)ri Arsenic(4393) <br /> INTENDED 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 i- Replacement Well r Well Alteration/Modification I Other <br /> Monitoring Well(s) #of wells -I Soil Boring(s) If of borings X Geotechnical 3 #of bodngs <br /> L Out-Of-Service Well Out-Of-Service Well Renewal I Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing �� <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary -Air Rotary Auger Cable Tool Push Point Other <br /> Proposed Well Depth 10-50 It Excavation 4.5 in diameter I Open Bottom Gravel Pack/Gravel Size in diameter <br /> I Conductor Casing in diameter / Conductor Casing Depth ft k"9 <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched _i Steel 1 Plastic Stainless Steel n Other O A <br /> Grout Seal Depth full depth ft X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix/7 galwptEr Q ZO�Q <br /> - Bentonite(20%solids) Other `�NJ <br /> Grout Placement Method Pumped Free Fall X Other Tremie -Retardant/Accelerator(name) /R Q(JIN co <br /> PEDESTAL Installed By _ Driller I Pump Contractor Other PgRTT 4 <br /> i Concrete Pedestal ]Dimensions:Width ft Length ft Thick in Christy Box 1 Stove Pipe MFNT <br /> PUMP 1 Submersible l_Turbine I I 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 /> WORKER PENSATION LAWS. <br /> IMU 8 O R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED PE GE#2295 TITLEVICe President,Engineering Services DATE 02/07/19 <br /> FSP RTMENT U E NLY <br /> Application Accepted By Data - Area Employee ID#� <br /> Grout Inspection By Date PECIAL WeII Permit <br /> Pump Inspection By Date - WAIVER Received <br /> Soil Boring Inspection By / Date Constructed Well Depth ft <br /> COMMENTS <br /> PE Sc Received Ch Amount Dto Permlt/ Invoice# WeI11D# <br /> Codes Info Remitted Se ice Re a t# <br /> EHD 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />