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t t <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(209)465-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> f/1 <br /> Joe ADDRESS 1601 S.Main Street CITYrbp Manteca/95337 <br /> CROSS STREET W.Atherton Drive APN 224-021-47o PARCEL SIZE 18.4 acres LAND USE APPLICATION# b <br /> OWNER NAME Rrnrrhini Family Partnership PHONE rn. <br /> OWNER ADDRESS 5451 E.Fig Ave. CITY/STATE/ZIP Manteca/CA/95337 <br /> CONTRACTOR West Coast Exploration Inc PHONE 209-965-7541 <br /> CONTRACTOR ADDRESS P.O.Box 133 CITY/STATE/ZIP Escalon/CA/95320 <br /> SUBCONTRACTOR/CONSULTANT C:TF Cal Inr PHONE 2nQ-F49-17Qg <br /> SUBCONTRACTOR/CONSULTANT ADDRESS 4230 Kieman Ave Ste 150 CITY/STATE21P Modesto/CA/95356 <br /> LICENSE x C-57 C-61 D-09 Other NUMBER 870761 EXPIRATION DATE 1/31/2022 <br /> BILLING PARTY: OWNER CONTRACTOR X SUBCONTRACTORICONSULTANT <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392) Arsenic(4393) <br /> INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring x Soil Sampling/Characterization <br /> Public Water System <br /> If 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) #of borings x Geotechnical 5 #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 <br /> Drilling Method Mud Rotary Air Rotary x Auger Cable Tool Push Point Other <br /> Proposed Well Depth 30 ft Excavation 4 inches in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth it <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth KQ ft x Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mix17 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method Pumped x 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 it 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 /> INIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Staff Engineer DATE 7/8/2021 <br /> SE:Q A"ACHED <br /> EEN <br /> QED <br /> Og ?021 <br /> E AENOUN TY <br /> R T MENT <br /> DEPARTMENT USE ONLY I G <br /> Application Accepted By ZL Date J7 C Area �4„Tc Employee ID# <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By 'Date 2 Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info Cas Remitted S ce Re uest# <br /> -MA IS1D 000 <br /> EHD 43-06 611112019 ^ / / WELL/PUMP PERMIT <br />