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WELUPUMP PERMIT <br /> 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 682 S.Main Street Crry21P Manteca,95337 m <br /> s <br /> CROSS STREET Industrial Park Drive APN 221-050-14~ PARCEL SIZE 8.07 LAND USE APPLICATION# o <br /> m <br /> OWNER NAME FPA Multi-Family LLC-Contact:Russell Shaw,Ph:559.676.8283 PHONE 415.925.3100 y <br /> OWNER ADDRESS 368 Jackson Street cm/STATE21P San Francisco,CA 94111 <br /> CONTRACTOR V&W Drilling-Contact:Karli Stroing PHONE Cell:209.981.7755 <br /> CONTRACTOR ADDRESS 1133 Blackhurst Drive CITYISTATEOP Galt,CA 95632 <br /> SUBCONTRACTORICONSULTANT PHONE <br /> SUBCONTRACTORICONSULTANT ADDRESS CITY/STATE/ZIP <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 720904 EXPIRATION DATE 04/30/2020 <br /> BILLING PARTY: OWNER =_CONTRACTOR SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural 7 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 IReplacement Well G Well Alteration/Modification r Other <br /> Monitoring Wells) #of wells 'i l Soil Boring(s) #of borings X Geotechnical 5 #of borings <br /> Out-Of-Service Well a Out-Of-Service Well Renewal a Cross-Connection Repair <br /> New Pump Pump Replacement ❑Pump Repair -, Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method X Mud Rotary Air Rotary ❑Auger ❑Cable Tool n Push Point i Other M <br /> Proposed Well Depth 10-25 ft Excavation 4 1/2 in diameter i Open Bottom ❑Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth It <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Schad a Steel ❑Plastic ❑Stainless Steel rl Other <br /> Grout Seal Depth full depth It )QNeat Cement(94 Ib bag/5-10 gal water) i i Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) n Other <br /> Grout Placement Method Pumped ❑Free Fall X Other Tremie a Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller ❑Pump Contractor ❑ Other <br /> Concrete Pedestal i-IDimensions:Width ft Length It Thick in ❑Christy Boz II Stove Pipe <br /> PUMP Submersible 'Turbine ri 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 /> WORailS. <br /> A E N (ICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNE TITLE_ Prosect Coordinator DATE 12/03/19 <br /> %)��� <br /> 05 <br /> -RNtJQ,q <br /> ?py <br /> E /0O pM'� N(47-y <br /> T�FNT <br /> TMENT USE QNLY r <br /> Application Accepted By Date Area l7 ployee ID# <br /> Grout Inspection By If Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By - Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Z5ecW Amount Date Permit/ Invoice# Well ID# <br /> Codes Info B s Remitted Service Regnest# <br /> EH043-06 61112019 /n� //��/}� WELL(PUMP PERMIT <br />