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1845 <br /> WELLIPUMP PERMIT <br /> SAN JOAQUINCOUNTY ENVIRONMENTAL IIEA�THDEPARTMENT 1868 EASTHA.-=I.TONAvENUE-STOCKTONCASS205-6232 (209)4613-3420 <br /> NON-REFUNDABLE PERMIT WWW.sigoy.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 14OSS7 CaStIe Rd. _ - _ _ CITv2w Manteca 95336 i A <br /> n <br /> CROSS STREET Northland Rd. _ 11 APN 197-12-077 PARCEL SIZE 1.90 LAND USE APPLICATION 9 <br /> DwriCR NAr.nr Albert Hemandez -- 6 Le 916 N <br /> _ PHONE { )649-0144 <br /> ONrIIER ADDRESS SAME 86S Pi Dt7Y-(,t.�jrq S� CITYISTATEOP � --..CA 9631'/ <br /> CONTRACTOR Delta Pump,Inc. PHONE (209)4W9625 <br /> CONTRACTOR AODRESs 646 S.California St. CITYISTATEILP Stockton,CA 95203 <br /> SUBCONTRACTORICONSULTANT PHONE <br /> SURCONTRACTORICONSULTANTADDRESS CITYISTATErbi, . <br /> LICENSE ! C-5; X C-61 -- D-W Other NUMMR 11155434 EXPIRATION DATE 7/31/W21 <br /> BILUNG PARTY: OWNER CONTRACTOR I I SUBCONTRACTOR/CONSULTANT <br /> DOMESTIC WELL SAMPLING:-1 General Mineral/Coliform Bacteria(4391)-1 Dibromochloropropane(4392)-1 Arsenic(4393) <br /> INTENDED USE X Domestic!Privatc -1 IrrigationAgricultural - Industrial -1 Water Quality Monitoring r Soil Sampling/Character¢ation <br /> I Pubkc Water System <br /> 'r d+9crect'ian•Owcr W.rrev Sfa.+n rlunr - Cwtdd Name yr Pivore Numbe• <br /> I' <br /> TYPQOfV*9W I New Well I Replacement Well Well AlleraticoModnccation Otter /IyT� <br /> -1 Monitoring Wells) AD of wells - Soil Borings) �'+hryma` r Geotecfnrucal •.r,., C A jV7. <br /> I putt-Service Wei <br /> X New Pump t Out-0!-Service Well Reny.wal Cross Connection Repair <br /> Pump Rrplacerrncrrt ' Pump Repair RalsP V%1elI Ca uru <br /> 'WELL CONSTRUCTION - .. <br /> Drilling Method j Mud Rotary L Air Rotary U Auger u Cable Tool _ Push Point _ (Xher SQ 2021 <br /> Proposed Well Depth_ft Excavation - in diameter I I Open Bottom I Gravel Pack Gravel Size EIy�IRd O <br /> J Conductor Casing in ilkarieler Conductor(rasing Depth 11 HEq�T 1 p,K T'q�T�' <br /> Well Casing Diameter_ in Ihickness•'Gauge•ASTM Sched I I Steel Plastic I Stainless Steel Other_ 4_IME)vT <br /> Grout Seal Depth R _ Neat Cement(94.1b bags f0 gat water) Sand Cement sack mrx/7 gal water <br /> Bentonite;20`W6 solids) I Other <br /> Grout Placement Method -. Pimped i Free Fall Other L Retardant I Accelerator(namey <br /> PEDESTAL Installed By Driller Pump Contractor Other <br /> Concrete Pedestal-1 Dimensions Width It Length <br /> p Thick in Christy Boz 11 Stove Pipe <br /> Pulp X Submersible_ Turbine .. Ot►ici HP 3 'Pump Set 120 It Aandinq Water Level 45 It <br /> 1 HEREBY CERTIFY THAT i HAVE PREPARED THIS APPLICATION AND THAT THE WORK 1VILL 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 FIM IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS <br /> r • <br /> U 1 <br /> R�UVA�CE NOTICE REQUIRED FOR INSPECTION- t'LEAS£CALI__ t?t1?tg5 X69; <br /> a '9 Trn.E CEO _ _ _ DATE &2Oi2O20 _ <br /> New house&shop pump located built.The <br /> behind the newly built shop. .. <br /> 0! <br /> w <br /> 7 �. <br /> Appliwlivu Accepted By Date Area <br /> Grout Irspection By Daft I SPECIAL Well Permit <br /> Pump Inspcctien By CQ eL-St•s.. %,KIS84f,,, Date WAIVER Received <br /> Soil Soft'ng fns lion By Date Constructed Well Depth ft <br /> CCMMLNIS P003�,bi l - <br /> PE SIC Received Check# Amnunr Permit! <br /> Codes Into B a Remitted Date Service R oast Invoice n Well ID# <br /> 0 os1 Wp00qd,q6 <br /> awn�:g C•'k'�:'9 ---- --- <br />