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t <br /> WELL/PUMP PERMIT <br /> 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 1110 North Main Street CITY/ZIP Manteca,95336 m <br /> East Louise Avenue 218-210-230-000 D <br /> CROSS STREET nAPN PARCEL SIZE 0.718 LAND USE APPLICATION# A <br /> OWNER NAME U Remainder LLC PHONE ,rn, <br /> OWNER ADDRESS On Bridge Plaza,Suite 260 CITYISTATE/ZIP <br /> CD <br /> CONTRACTOR Salem Engineering Group,Inc. PHGNE 559-271-9700 7 <br /> O <br /> CONTRACTOR ADDRESS 4729 West Jacquelyn Avenue CITY/STATEZP Fresno,California 93722 , <br /> SUBCONTRACTOR/CONSULTANT Salem Engineering Group.Inc. PHONE 559-271-9700 <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 4729 West Jacquelyn Avenue Cm/STATEZP Fresno,California 93722 <br /> C/1 <br /> LICENSE V C-57 ' C-61 1 D-09 Other NUMBER 970772 EXPIRATION DATE 3/31/2020 <br /> r7 <br /> BILLING PARTY: DOWNER CONTRACTOR J SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE DomestictPrivate Irrigation/Agricultural Industrial Water Quality Monitonng ✓Soil Sampling/Characterization r, <br /> Public Water System w <br /> If different from Ovmer: Water System Name Contact Name or Phone Number n <br /> TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other O <br /> Monitoring Well(s) #of wells � Soil Boring(s) #of borings V Geotechnical Seven #ofbrnings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair w <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary 1 i Air Rotary +/Auger Cable Tool Push Point Other <br /> Proposed Well Depth-44141IS-'33ft Excavation in diameter I Open Bottom 1 1 Gravel Pack/Gravel Size in diameter <br /> 1 Conductor Casing in diameter / Conductor Casing Depth ft <br /> -WeN Casiog Diameter_in Thickness/Gauge/ASTM Schad Steel i�Plastic 1 Stainless Steel Other <br /> Grout Seal Depth 15 to 35 ft ✓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 V Free Fall ✓Other Tremmie Retardant/Accelerator(name) <br /> ipsBESTR[- Installed By i!Driller -1 Pump Contractor I Other <br /> IIr I Concrete Pedestal i IDimensions:Width ft Length ft Thirk in 1 Christy Box 1 Stove Pipe <br /> WYMP. Submersible;i 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 /> NI UM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Geotechnical Staff Engineer DATE 3/19/2020 <br /> PAYMENT <br /> RECEIVED <br /> MAR 2 6 2020 <br /> AN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> EA LTH DEPARTMENT <br /> EPARTMENT USE q�NIL <br /> Application Accepted By / Date �.3"Z�' Area � /"x+11 �`1 Employee lD# Dga_V � <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COOM�MENNTTS � , Yq 8 � � � <br /> � <br /> — — — — -- <br /> PE SC Received e-'15hecW Amount Date Permit) Invoice# Well ID# <br /> Codes Info Remitted Service oa <br /> IR st# <br /> 7 C7LZV <br /> 3 s <br /> EH0 4}06 6/11/2019 WELL PUMP PERMIT <br />