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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468.3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 4000 Aplicella Ct. Cl Manteca 95337 {m <br /> CROSS STREET S.Williamson Road APN 24174009 PARCEL SIZE LAND USE APPLICATION# O <br /> OWNER NAME City of Manteca PHONE 209.239.8400 <br /> OWNER ADDRESS 1001 West Center Street CITY/STATE/ZIP-Manteca,CA 95337 <br /> CONTRACTOR ENGEO Incorporated PHONE 209-684-7615 <br /> CONTRACTOR ADDRESS 17278 Golden Valley Parkway CITYISTATEZP Lathrop,CA 95330 <br /> SUBCONTRACTOR GEO-Ex Subsurface Exploration PHONE g16-799 8198 <br /> SUBCONTRACTOR ADDRESS 1510 Madera Dr Cm/STATE/LP Dixon,CA 95620 <br /> LICENSE X C-57 C-61 D-09 Other NUMBER 954267 EXPIRATION DATE 07-31-2022 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water(Duality Monitoring X Soil Sampling/Characterization <br /> Public Water System <br /> It different from Owner: Water System Name Comad Name or Phone Number <br /> TYPE OF WORK _ New Well Replacement Well D Well Alteration/Modification Other <br /> Monitoring Well(s) #of wells L;Soil Borings) #of borings X Geotechnical 1 #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump ;Pump Replacement L Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary --I Air Rotary Auger Cable Tool X Push Point Other <br /> Proposed Well Depth 100 It Excavation 2 inches in diameter Open Bottom ❑Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter in Thickness/Gauge/ASTM Sched I Steel Plastic - Stainless Steel Other <br /> Grout Seal Depth ft X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack niW7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method X Pumped Free Fall Other Retardant/Accelerator name <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width ft Length ft Thick in Christy Box Stove Pipe <br /> PUMP Submersible Turbine Other HP Pump Set ft 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 /> MINIl 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED (,K�Y�\L�•i„wp,SL-. TITLE Project Engineer DATE 7/27/20 <br /> Fc MFNT <br /> - F��FO <br /> USN C <br /> pqR�Jill TY <br /> T <br /> DEPARTMENT US- Y <br /> Application Accepted By ���-l Date C-) Area Employee ID# _ <br /> Grout Inspection By Date I SPECIAL Well Permit <br /> Pump Inspection By /' Date I WAIVER Received <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ ount Date Permit/ Invoice# Well ID# <br /> Codes Info Cash Remitted Service Request# <br /> Vql,7jN 533- <br /> EHD 4306 ra` 04/14/18 /// <br /> ^35)1 WELL/PUMP PERMIT <br />