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4 <br />WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT www.siqov.orqlehd EXPIRES 1 YEAR FROM DATE ISSUED <br />...; A ‘ _ I, , , frvi , (See APN's on "Property and <br /> <br />JOB ADORES. SO #4 prp57.1 lidny iti We; 10 Boring Information Table" below) CITY/ZIP Manteca, CA 95337 <br />varies (see table below) ApN varies (see table) CROSS STREET PARCEL SIZE LAND USE APPLICATION # <br />Union Pacific Railroad (UPRR) [Borings B-01 and 6-03 to B-11) UPRR: 402-544-5000 <br />OWNER NAME South San Joaquin Irrigation District (SSJID) (Boring B-02] PHONE SSJID: 209-249-4600 <br />UPRR Address: 1400 Douglas Street Omaha, NE 68179 <br />OWNER ADDRESS SSJID Address: P.O. Box 747, Ripon, CA 95366 Crrv/STATE/ZiP Ripon, CA 95366 <br />CONTRACTOR Taber Drilling, Inc. PHONE 916-371-8234 <br />CONTRACTOR ADDRESS 536 Galveston Street Cry/STATE/Zip West Sacramento, CA 95691 <br />SUBCONTRACTOR/CONSULTANT -(DR Engineering, Inc. (c/o Vic Crosariol) PHONE 510-316-8861 <br />SUBCONTRACTOR/CONSULTANT ADDRESS 2365 Iron Point Road, Suite 300 CITY/STATE/ZIP Folsom, CA 95630 <br />UCENSE X C-57 C-61 D-09 Other NUMBER 969927 EXPIRATION DATE 02/28/2022 <br />BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring XSoil Sampling/Characterization <br />Public Water System <br />It different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK New Well Replacement Well Well Alteration/Modification Other <br />Monitoring Well(s) # of wells Soil Boring(s) 4 d b.wings XGeotechnical 11 # of borings <br />Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br />New Pump Pump Replacement Pump Repair Raise Well Casing <br />WELL CONSTRUCTION Hollow stem <br />Drilling Method kMud Rotary$0 Air Rotary XAuger Cable Tool Push Point Other <br /> <br />Proposed_Wett Depth itoi.0 (see ft Excavation 8 in diameter Open Bottom Gravel Pack/Gravel Size N/A in diameter <br />Boring ContE or Casing N/A in diameter / Conductor Casing Depth N/A ft <br />Well Casing Diameter N/A in Thickness/Gauge/ASTM Sched N/A Steel Plastic Stainless Steel Other <br />Grout Seal Depth full depth ft )(Neat Cement (94 lb bag/5-1O gal water) Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped Free Fall )(Other Tremie Retardant/ Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other N/A Concrete Pedestal Dimensions: VVidth ft Length ft Thick in Christy Box Stove Pipe <br />PUMP N/A Submersible Turbine Other HP Pump Set ft Standing Water Level ft ..L <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SA 4 <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE'S Y4/1 <br />WORKERS COMPENSATION LAWS. Cp CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH .4W • el <br />-... / <br />SIGNED <br />M 48 H DVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />Tim, Executive Vice President DATE 04.15.2021 APR 2 , 1 202/ <br />IJIN ,,, <br />P',,V3:14.1V--4 Lv TY , ,m47. <br />Z <br />---DEPARTMENT USE ONLY <br />Date LI Al0 Area:/tYll'',41Employee 104 A& <br />Date SPECIAL Well Permit <br />WAIVER Received <br />Constrpited We Dept ft <br />11 t Ufl c,,e,p,th to (Ye/ (4)1 <br />PE <br />Codes <br />SC <br />Info <br />Received <br />a #71 <br />Check#I <br />Cash <br />Amount R,mitted Dat <br />Permit/ <br />Service Reguegt # Invoice # Well ID# <br />14 3742 WO ‘,- $ lq76 ,so.—/1121 <br />A i iii <br />MOO tf ri I <br />EHD 43-06 6/11/2019 <br />/-372a/ sp <br />WELL /PUMP PERMIT <br />Property and Boring Information Table (See attached Figures 1 to 11 for boring location site plans) r <br />1 1 I I I I <br />Boring Number <br />I I I III I I I I <br />Approximate Boring Depth <br />(feet) <br />I II I i I I I II <br />Assessor's Parcel <br />Number (APN) <br />I I 1 I IIIIII <br />Property Owner <br />Nearest Cross <br />Street to UP <br />Railroad <br />II <br />Boring <br />Location <br />C <br />B-01 45 19801004 UPRR E Louise Avenue 2 <br />B-02 45 19811007 SSJID E Louise Avenue 2 <br />B-03 20 19811009 UPRR S Airport Way 3 <br />13-04 35 20201001 UPRR S Airport Way 4 <br />8-05 35 20001004 UPRR W Louise Avenue 5 <br />13-06 35 21703047 UPRR N Union Road 6 <br />8-07 35 21705040 UPRR N Walnut Avenue 7 <br />B-08 35 21715012 UPRR W Center Street 8 <br />B-09 35 21939021 UPRR W Yosemite Avenue 9 <br />B-10 35 22103024 UPRR S Main Street 10 <br />B-11 20 22114015 UPRR Spreckels Avenue 11 <br />Note: See Figure 1 for view of overall project area <br />Application Accepted By <br /> <br />Grout Inspection By <br /> <br />Pump Inspection By Da <br /> <br />Soil Boring I pection 13y Da <br />CApP MMENTS Je I Zr Sc.lb I <br /> <br />erarC Mu( ar o be