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WELLIPUMP PERMIT <br /> SAN JOAGUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTONAVENUE-STOCKTON CA 86205.6232(209)4683420 <br /> NON-REFUNDARLF PERMIT _ www.sj oV.or lehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joa ADDRESS N99 S Austir.Road /Wj-'r0 Np,WrC4'5f e— CITylZIP Manteca,CA 95339 <br /> 20f08005,20108D07. 9397.83.0, > <br /> CROSS STREET SOUth Of Arch Rd. APN 18115007 PARCEL SIZE'103-,, LAND USE APPLICATION <br /> ao110 t9a r <br /> OWNER NAME Ameresco 6,c � �' ,� PHONE 209-982 4298 ib <br /> OVO4ERADDRESS III Speer Street Suite 140 0fp0 i 06 O Q r� CrTY/STATEIM P Framu,gham MA 01701 <br /> CONTRACTOR Tetra Tech )6(, O O PHDNE` 909-860-7777 <br /> CONTRACTOR ADDRESS 21700 c'opley Dr.,#200 CITYISTATEIZIP Diamond Bar,CA 91765 <br /> SUBCONTRACTORICONSULTANT Moore Twining As9cciates PHONE 559-268.7021 <br /> SIJRCONTRAC'rOWCOtJ8ULTANTADOREss 2572 FreasnD Sl. CITY/STATEJZfp Fresno,CA 93721 <br /> LICENSE Kj C-57 I I C-61 D-09 0 Other NUMBER 508159 EXPIRATION DAVE 02/28/2021 <br /> BILLING PARTY: r OWNER :?(CONTRACTOR U SUBCONTRACTOWCONSULTANT <br /> DOMESTIC WELL SAMPLING:D General Mineral/Coliform Bacteria(4391)n Dibromochloropropane(4392)C Arsenic(4393) <br /> INTENDED USE U D Dmeslic/P rivals -j IrrigationlAgriwltural 1-1 Industrial Water Quality Monitoring X Soil SamplingrChafeclerizetion <br /> 0 Public Water System <br /> If daroro"t fJom Owuar Water System Name Conlacl Narru or Phots."klmlmi <br /> TYPE OF WORK 'I New Well ❑Replacement WAIT I,j Well ADerstionlModification U Other <br /> Monitoring Wells) it of wells ?Soil 8oring(s) a of Da""0% X Geoteehnical 5 e or Cotin9e <br /> - <br /> 0ut01-8eivice Well J 0utOfSorvil+R Woll Reri U Cross-Connection Repair <br /> New Pump 0 Pump Replacement n Pump Repair n Raise Well Casing <br /> WELL CQNSTRUC110fJ <br /> Dritling Method n Mud Rotary D Air Rotary Y Auger u Cable Tool U Push Point _ Other <br /> Proposed Well Depth 50 It Excavation 6" in diameter rl Open Bottom n Gravel Pack/Gravel Size in diameter <br /> n Oonduclor Casing in diameter I Conductor Casing Depth It <br /> Well Casing Diameter_in ThicknesslGaugeIASTM Schad n Steel n P antic n Stainless Steel D Other <br /> Grout Seal Depth 50 it x Neal Cement(94 lb bag/510 gal water) F.Sand Cement sack nixf7 gal water <br /> n Bentonite(2O%solids) ❑other <br /> Grout Placement Mothed X Pumped ❑Free Fall r]Other n Retardant J Arcelera:or(name) <br /> PEDESTAL Installed By n Drier n Putip Contractor ❑ Other <br /> u Concrete Pedestal LDimensions.Wdth h Length 0 Thick in -Christy Box n Stove Pipe <br /> (PL'I,IP u SubmersibleU Turbine U Other HP Pump Set fi 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 M COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Staff Geologist DATE March 3 2020 <br /> '777-1— <br /> Ile! <br /> I I I I I I I I l I I I 1 ( _�.,.-1�.,_ _ -+.. -_.. _+- � J� • M/�N <br /> R <br /> Vi—I� - �_ I t_ I 1 <br /> I l I A I I I I I I I <br /> N�yFCOVNT_ <br /> I 1 I L <br /> -- l . <br /> D /1/EPARTMENT S ONLY { (� <br /> ApplicahenAccepled By Gy.S����T'g"�^•� Date 3 tJ z� Area / -7� Earployee lDtJ <br /> Grout Inspection By—_ Date—__ u SPECIAL Well Permit <br /> Pump Inspection By DateLJ WAIVER Received <br /> Soil Boring Inspection Ey_ Lt� Data sT,. G Z 6 Constructed Well Depth tt <br /> COMMENTS _ _--__ <br /> PE SC Received Check#1 Amount D to Pormit/ Invoice# Well IDX <br /> Codes Info aSf, Remitted Scrvico Roauest# <br /> Iso IL— ►o ;I // �QCZ 1� <br /> E1113e3Ce o111130KI '• •LYIT 111'UNP Pf-RIAn <br />