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FIELD DOCUMENTS
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EHD Program Facility Records by Street Name
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MACARTHUR
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2401
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2900 - Site Mitigation Program
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PR0009269
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Last modified
3/3/2020 4:44:20 PM
Creation date
3/3/2020 4:37:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0009269
PE
2960
FACILITY_ID
FA0004006
FACILITY_NAME
LEPRINO FOODS
STREET_NUMBER
2401
Direction
S
STREET_NAME
MACARTHUR
STREET_TYPE
DR
City
TRACY
Zip
95376
APN
21307050
CURRENT_STATUS
01
SITE_LOCATION
2401 S MACARTHUR DR
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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\ WELL/PP1fP PERMIT <br /> . � SAV JOAQUIN COU.YTV EYVIROVNEVTAL 4 DEPARTMENT JOIE WEBER AYEJ" OCKTOY CA 95302-(209)468-3420 <br /> NON-REFUNDABLE <br /> EE�PERMIT CALL <br /> CALL209953-7697 FOR INSPECTION$ YEAR FROM DATE ISSUED <br /> JOBADDRESS rIM1 t rTic- „V r 3—ft+.` C."... ` 15!51n <br /> /l ' <br /> O <br /> CROSSSTREET Gr; V+ kM�.r1��-�rL%rlAa��� A/P�\'A 13 -0T —CL9 PARCELSIZE 9arres <br /> OW^.vEa NAMe G'I YGeIAO- . - IL1_o i fes. /t12W''Q (I/l r/L Pxove ^ <br /> g 5.a r2C- <br /> ON'yERADDRESS T CITY/$TATFJZIP <br /> COVTRACfOR "d^��/I P -• txL . LAI <br /> fg.� �'g_ <br /> CONTRACTOR ADDRESS '3G%C�"jnin-( - 1 -612210 CITI'/STATE P f�.f( Il1Q. l 11 -SeAa2Y. <br /> SUBCONTRACTOR PNOVE <br /> Z64 777 35"70 <br /> \ L f <br /> SUBCONTMCIOR ADDRESS CITY/STATE/ZIP aI�QY�AI�W�iFi/cA Z�L- <br /> r V <br /> LICENSE ✓2`C-57 C3 C-61 0D-09 �P❑EO�tther ryQ/y�� NUDI9ERUaUG= EXPIRATIOBDAie <br /> A <br /> GEOGRAPRICALINFORMTION: Coordinates 1I VIII 4- /ry gL1g1 �x Township_ Range_ Section <br /> INTENDED USE 13Domestic/Pdvate ❑Irtigodon/Agricultunl ❑Industrial rpWater Quality Monitoring ❑Soil Sampling/Chaaaerization <br /> D Public Watersyystam <br /> Udiff Ilomener. .Ic, ntem .m. omact .moor one .mw <br /> TTEOFWORR 13 New Well ❑Replacement Well ❑Weil Alteration/Modification ❑Test Hole El Other <br /> )tMonimring Well(,)_ "'"b""'-o"D MSoil Boring(s)_ a.mbn.1 Mnnaa ❑Geolechnieal numMofaorinyf <br /> ❑Well Destaction ❑O.'--Of-Scrvice Well ❑Out-ofgervice Well Renewal <br /> 13 New Pump 0 Pump Replacement 13 P.m,Re air ❑Cross-Connection Repair <br /> WELLCONSTRUCr1ON <br /> Drilling Method ❑Mud Entery ❑Air Binary ❑Au er ❑Cable Tool Aush Point [3 Other <br /> r Proposed 1 <br /> Well Depth 18 Excavation=iodiameter 13 Open BDDom C3 Grovel Pack/Grovel lurcjV�jj indiameter <br /> Cl Conductor Cuing indiameter / Conductor Casing Depth C,27k2 fl <br /> Well Casing Diameter I in Thickness/Gauge/ASTM Schad 13 Steel pulestic D Stainless Steel DOther <br /> Grout Seal Depth 1A ft .Neat Cemem f94166ag/5-10 got wore) ❑Sand Cement suck mixt 7 gal water <br /> ❑Mennonite(20%solids)) 13 Manufacturer Spec%solids_% Name ❑SPecson File ❑Specs Submitted <br /> Grout Placement Method ❑Pumped p/Fra Fall ❑Other O Retardant/Acceleatur(name) <br /> PEDESTAL Installed By XbrillR 13 Pump Comactor ❑Other <br /> ❑Concrete Pedestal Dimensions: Width R Length_It Thick in Christy Has ❑Stove Pipe <br /> PUxP ❑Submersible ❑Turbine g Other noM, HP Pump Set R Sanding Weler Level ft <br /> WELLDESTRUCTION F)Open Bottom ❑Gavel Pack ❑Uncased ❑Other <br /> Weil Diameter_in Total Depth It Depth to Water R ❑Casing to be Perforated from fl to_It <br /> Sealing Material ❑Neat Cement 19416 bog/5-10 gal emery 13 good Cement sock mu/7 gal water D Bentonite Pellets <br /> ❑Bentonia(20%solids) ❑Manuracmrer S,r%Solids % Name OSpason File ❑Spre,submined ` <br /> Placement Method E3 Pumped ❑Free Fell ❑Other <br /> D Complete with Mushroom Cap_A below gnde ❑Complete to Existing Surface Pad <br /> 1 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 /> j��j/// ;111NIN <br /> a��iAI241IOURADVANCENO'rICr,"�Fn111REEDFORINSSPECTIONS(-SIGNED TITLE � DATE/ /" <br /> V <br /> DEPARTMENTUS ONLY <br /> Application Accepted By Date Z D Area Employee IDn <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received <br /> Destruction Inspection By Date Constructed Well De th It <br /> COMMENTS <br /> rt <br /> &C ok Ad L14 <br /> PE $C Amount ChecWl/ Berthed Date Permit/ Involccil Wall IDN <br /> Codes Info Remitted Cash By Senitt Be..estp <br /> EHD 43-02-0060 D Marr water Well Permhdor <br /> 8/20/2007 <br />
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