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ehwellandsepticpermits@sjgov.org <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 -6232 (209) 468-3420 <br />NUN-KEFUNDABLE PERMIT www.stgov.org/enc C1G'I111=0 T TEAR FROM UAIt ISSUED <br />JOB ADDRESS 144, 292, 301, and 490 Quintal Road CITY/ZIP Manteca 95337 <br />See <br />CROSS STREET S Main Street APN See Attached PARCEL SIZE Attached LAND USE APPLICATION # <br />Arditi Properties O <br />OWNER NAME j � PHONEj, L <br />OWNER ADDRE: g o a O L4,3 f "4 Ave V YI 1 / © CITY/STATE/LP see'+A- <br />/ ,S ' 9 811 a <br />CONTRACTOR JfRockridge Geotechnical, Inc. attn Darcie Maffioli PHONE 530-514-4889 <br />CONTRACTOR ADDRESS 270 Grand Avenue Cm/STATEZP Oakland, California 94610 <br />SUBCONTRACTOR/CONSULTANT ConeTec, Inc. <br />PHONE (510)357-3677 <br />SUBCONTRACTOR/CONSULTANT ADDRESS 820 Aladdin Avenue CITY/STATE21P San Leandro, CA, 94577 <br />LICENSE VC -57 C-61 D-09 Other NUMBER 1049248 EXPIRAnONDATE 1/31/2023 <br />BILLING PARTY: OWNER CONTRACTOR SUBCONTRACTOR/CONSULTANT <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />NTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring V 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) n of borings Geotechnical 16 a of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />Drilling Method Mud Rotary Air Rotary Auger Cable Tool Push Point V Other Cone Penetration Tests <br />Proposed Well Depth 50 It Excavation 1.7 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 Steel Plastic Stainless Steel Other <br />Grout Seal Depth 50 ft VNeat Cement (94 lb bag/5-10 gal water) Sand Cement sack mix/7 gal water <br />Bentonite (20% solids) Other <br />Grout Placement Method Pumped VFree Fall VOther tremie if applicable Retardant / Accelerator (name) <br />PEDESTAL N/A Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width If Length It Thick in Christy Box Stove Pipe <br />PUMP N/A 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 />MINI M 48 ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED It, � � w" TITLE Operations Manager, ConeTec DATE 09-22-2021 <br />Application Accepted By—�� <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS PIV','CX <br />DEPARTMENT USE ONLY <br />Date q147 ? a <br />Date <br />Date <br />" Date C\I.O-LA <br />Area S,"Lei i?cc' Employee ID# r 'i <br />SPECIAL Well Permit <br />WAIVER Received <br />Constructed Well Depth ft <br />CFENT <br />QED <br />:P 2 3 ?021 <br />D pqR MNTy <br />PE SC Received <br />Codes Info <br />Check#/ <br />jCash <br />Amount Date Permit/ Invoice # Well ID# <br />Remitted Service Request <br />7a o <br />So-- <br />4t773 <br />EHD43-06 6111!2019 /j2— 1 <br />--? FSY/ WELL/PUMP PERMIT <br />