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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARIMEH- 1988 EAST HAILL Tom AvENuE-STOCKTON CA 95205-6232(209)468-3420 <br /> NON-REFUNDABLE PERMIT WWW.SJQOV.Orn/ehd _EXPIRES 1 YEAR FROM DATE ISSUED <br /> JoeADDREss 751 W Lowell Av n l . CITfInP Tracy- .A 45376 <br /> CROSS STREET N Tracy 81vd APN 2321 6002 PARCEL SIZE LAND Use APPLICATION x <br /> OWNER NAME Tracy_Unified School Dist 1cL PHONE 1Q9-830-3200 <br /> OWNER ADDRESS 1875 W Lowell Avenue-.______ CrtY/STATvzw Tracy,CA 95376 _ <br /> CONTRACTOR Middle Earth Geo Testing, Inc. PHONE 714-633-5025 _ <br /> CONTRACTOR ADDRESS 954 No Lemon Street __. CITYISTATEZP Orange, CA 92767 <br /> p _ <br /> SUBCONTRACTOR/CONSULTANT �K ASSDciates PHONE 916-853-9293 <br /> SUISCONTRAC TOWCONSUL CANT ADDREsS 3140 Gold Camp Dr.#160 crrY!STATE)Z1Pf�aMh1 _Qf_dY334 CA 95670 <br /> LICENSE x C-57 C-61 0-09 Other_ . . _ NUMeeir 899451 EXPIRATION DATE 06/30/2021 <br /> BILLING PARTY. OWNER CONTRACTOR SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING: General MlnerallColitorm Bacteria(4391) Dibromtxhloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domeshc'Private ItTgetionlAgricultural Industrial Water Quality Monitoring X Soil SamdingiCharacterl2awn <br /> Public Water System <br /> r.cd w_t 4^m O+me, W.I.System NA Car4w Marne w IN—Number <br /> i <br /> TYPE OF WORK New Well Replacement Well Well AlteraeoniModlfieahon Other <br /> MDIrT ortrtg Weeks) N of werls SOI/Bormg(s) x&ppen9' X Geotechnical�e w axrgs <br /> Out-O'-Service Well OUI-OI-Service Wei Renewal Cross-Connection ROD&+r <br /> New P.,mp Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Dnlhng Method Mud Rotary As Rotary X Auger Cable Tool Push Point Other <br /> Proposed Well Depth 50 tt Excavallon 1.5 In diameter Open Bottom Gravel PaduGravel S¢e n diameter <br /> Conductor Casing In diameter / Conductor Casing Deom R <br /> Well Casing Diameter_in ThlckrexsrGauge/ASTM Schad Steel Plastic Stainless Steel Omer <br /> Grout Seal Depth 50 h X Neat Cement(94 1b bagl5-10 gat water" Sand Cement .sack m;x17 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped Free Fall Xother CPT rods/tremmle Retardant IAcodersdor(name) <br /> PEOEET& Installed By OrWx Pump Contractor Other <br /> Concrete Pedestal Dimensions Width IT Length R Thick in Christy Box Stow Pipe <br /> 1ELEP Submersible TUrbinrl Other HP Pump Sel R Staking Water Level It <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, TIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPUANCE WITH ALL <br /> WORKERS C E SATtO LAWS. <br /> MIN ADVANCE NOTICE REQUIRED F INSPECT? NSfPLE SECALy1209)953-7897 <br /> SW.KD k7ZP2ATE /L <br /> R AYMENT <br /> ECEivED <br /> JUL 3 01010 <br /> H# <br /> RO U/N C1-1-1±k �UN <br /> TyDE ARThiew <br /> DEPARTMENT USE.ONLY <br /> Application Accepted By _ Date Jct L Aroa S- /T rl Ct Employee IDN f <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Puny Inspection By DateWAIVER Received <br /> Sod Boring Inspection By. lik"LP't L{t^, Data ... Constructed Wall Depth IT <br /> COMMENTS <br /> PE Sc RscelvWAmount Owls est <br /> Invoice N 11111110111 Will <br /> coon 1111110RM1kbd Ice Re nest e <br /> } <br /> EHD43400 6112019 WELL PW/P PERIMT <br />