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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HE-ALTN DEPARTMENT 1 W EAST HAZELTON AVENUE•STOCKTON CA 95205 6232(209)40.3420 <br /> NON-REFUNDABLE PERMIT WWW.b OV.Or ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> Joe ADDRESS 1701 S Central Avenue CITYIL► Tracy_CA 95376 <br /> CROSS STREET Regina nrlVP APN 24606004 PARCEL SIZE�1�LAND USE APPLICATION P <br /> OWNER NAME Tracy Unified School District <br /> OWMER ADDRE9s 1875 W Lowell Avenue CITY/STATEIDP Tracy, CA 95376 <br /> CONTRACTOR Middle Earth Geo Testing, Inc. PrwNE 714-633-5025 <br /> CONTRACTOR ADDRESS 954 N Lemon Street CITYrSTATErz,P Orange. CA 9p2767 <br /> SUSCONTRACTORICONSULTANT RSK SSOCiateS PrroNE 916-853-9293 <br /> SUSCONTRACTORICONSULTANI AODRESs 3140 Gold Camp Dr.#160 __ CrrytSTATEMP l all}hoyDrdova. CA 95670 <br /> LICENSE x C-17 rfit 0-09 Omer NUMBER 894451 ExPIRATION DATE. 0630/2021_ _ <br /> BILLING PARTY: OWNER CONTRACTOR }; SUBCONTRACTOR/CONSULTAMT <br /> DOMESTIC WELL SAMPuNIG: General Mineral/Coliform Bactena(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> {"TENDED USE ,r e,,rjphvate I,rQ pONA,,hCU,,u,aI Induslnal Water Quality Moneonng X Sod Sampling/Characte,41I.n <br /> Public Water System <br /> a amerent Nom O_ v,—,5,.W-Nero Cores0 Nerve a Pone Ni~ <br /> TYPE OF Wow New Well Replacement Wel Well AReratlorvModricavon Other <br /> Monitoring Wells) R of weds Sal Bormg(s) ."°_N, X Geotechrecal —e dtw y <br /> Out-Of-Service Well Oul-Of•Se wce Well Renowal Cross-Connection Repan <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method M,,d Rotary Xr Rotary X Auger Cagle Tod Push Pant Other <br /> Proposed Well Depth 50 n Excavation 1.5 .n diameter Open Bottom Gravel Pack7Gravel Size in diameter <br /> Conductor Casing in diameter r Conductor Casing Depth R <br /> Well Casing Diameter_in Thckness,'Gauge%ASTM Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 50 It X Neat Cement(94 Ib bag/5-10 gal water) Sand Cement Sack mrr17 gal water <br /> Bentonite i20%sdxls) Other <br /> Grout Placement Method Pumped Free Fall X Other CPT rOdS/iremmle Retardant l Accelerator tnamc) <br /> STAL Installed By Drder Pump Contractor Other <br /> Concrete Pedestal Dimensions Width R Length h Thick :n Christy Bos Stove Pipe <br /> PUMP S,br+ers:ble Turt.h, Other HP Pump Set R Standing Wa!er Level it <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORN WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES. STATE LAWS. AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND AFJIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT i AM IN COMPLIANCE WITH ALL <br /> WORKERSCO An S <br /> MINI N 7il) VANCE NOTI E REQUIRED f INSPE a0 PL ASE CALL 209)953-7697 <br /> SI TIT,E M" Alm DATE 1-f-� <br /> F FNr <br /> 30?OO <br /> v/N c <br /> OU <br /> ARTMLNTY <br /> // DEPARTMENT USE.ONLY tr <br /> APPI.cal,on Accepted By ` Dets 7 J r3J L7 Area , Employes IDN <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Purlp Inspection By Date WAIVER Received <br /> Sod Bonng Inspection By ff&Vl Date 2 L7 Constructed Well Depth __ n <br /> COMMENTSPE Sic <br /> Cedes Ylfo ReC RB t Dow --Service Request a I^ *III <br /> Well we <br /> 7d 273 <br /> a <br /> END43-M $1112019 WELL,PUMP PERMIT <br />