Laserfiche WebLink
WELUPUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 -6232 (209) 468-3420 <br />NON-REFUNDABLE PERMIT ......• ^ ^^ ^'^f^tea EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDREsr r�' 3�, lCa �rt I DTCITY2IP Manteca / 95337 <br />224-040-09,and 224-040-04 <br />CROSS STREET At helrlOY1 APN's PARCEL SIZE LAND USE APPLICATION # <br />OWNER NAME Boyce Resources dba Boyce Holdings, LLC - Albert Boyce, Manager PHONE 209.239.4014 <br />OWNER ADDRESS P.O. BOX 1870 CITY/STATEMP Manteca, CA 95336 <br />CONTRACTOR V m W Drilling - Contact: Karn Stroing, President PHONE 209.469.7700 <br />CONTRACTOR ADDREas 1133 Blackhurst Drive CirrY/STATEIZIP Galt, CA 95632 <br />SUBCONTRACTOR/CONSULTANT Condor Earth - Contact: Ron Skaggs, GE 42295 PHONE 209.234.0518 <br />SUBCONTRACTOR/CONSULTANT ADDRESS 188 Frank West Circle, Suite 1 CRY/STATE/7JP Stockton, CA 95206 <br />LICENSE X C-57 C-61 D-09 Other NUMBER 720904 EXPIRATION DATE 04/30/2022 <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 Soil Sampling/Characterization <br />Public Water System <br />If different from Omer. 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 Borings) # of borings X Geotechnical Iq# 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 10 to 30 It Excavation 4.5 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 Schad Steel Plastic Stainless Steel Other <br />Grout Seal Depth full depth It X Neat Cement (94 Ib bag/5-10 gal wafer) Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped Free Fall X Other Tremie 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 />MINI UR AD C QUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE Project Coordinator DATE 09/13/2021 <br />DEPARTMENT USE ONLY <br />Application Accepted By L— Date 7 21 <br />Grout Inspection By Date <br />Pump Inspection By Date <br />Soil Boring Inspection By Date VD 1 I ® IZ L <br />COMMENTS Z AAO o0.s�. W.S C]JSN <br />Area1?OEmployee ID#_IS <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />T <br />r� <br />g <br />,YMENT <br />CEIVED <br />2 0 2021 <br />QUIN COUNTY <br />ONMENTAL <br />DEPARTMENT <br />EHD 4306 6111/2019 <br />604 1$- X31 s ! le—/ HJ 2-/ WELL/PUMP PERMIT <br />41 <br />