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D <br />9211 T/Ag <br />( WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NUN-KEFUNUABLE PERMIT <br />GALL (LUV) yOJ-/OV/ FOR INSPECTIONS <br />LAVIKtS l TEAR FROM DATE ISSUED <br />JOB ADDRESS <br />26850 N Lower Sacramento Rd <br />CITY/ZIP <br />Galt, CA 95632 <br />CROSS STREET Liberty <br />Rd APN 005-030-070 <br />PARCEL SIZE 70 acre SLAND USE APPLICATION # <br />OWNER NAME <br />Ventana Development Co., Inc.��%�/'. <br />ONE (408) 279-1520 ext. 7142 <br />11 <br />OWNER ADDRESS <br />55 Market Street, Suite 1210 <br />CITY/STATE/ZIP <br />San .lose, CA 95113 <br />CONTRACTOR <br />Eaton Drilling Co., Inc. <br />PHONE 530-662-6795 <br />CONTRACTOR ADDRESS <br />20 W Kentucky Ave <br />CITY/STATE/ZIP <br />Woodland, CA 95695 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS <br />CITY/STATE/ZIP <br />LICENSE E C-57 C-61 <br />I D-09 Other <br />NUMBER 133783 <br />EXPIRATION DATE 7/31/2020 <br />DOMESTIC WELL SAMPLING: i i General Mineral/Coliform Bacteria (4391) i Dibromochloropropane (4392) 1 1 Arsenic (4393) <br />NTENDED USE D Domestic/Private 0 Irrigation/Agricultural Industrial Water Quality Monitoring Soil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK Y New Well Replacement Well Well Alteration/Modification Other <br />Monitoring Well(s) # of wells Soil Boring(s) *of borings Geotechnical # of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />WELL CONSTRUCTION <br />Drilling Method ■ Mud Rotary D Air Rotary Auger Cable Tool Push Point ■ Other Reverse Rotary <br />Proposed Well Depth 1 150 ft Excavation 28 in diameter Open Bottom 8 Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter 16 in Thickness/Gauge/ASTM Sched 0.250" B Steel I Plastic i Stainless Steel Other <br />Grout Seal Depth 50 ft G Neat Cement (94 /b bagl5-10 gal water) N Sand Cement 10.3 sack sack mixR gal water <br />Bentonite (20% solids) ❑ Other <br />Grout Placement Method O Pumped Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller 8 Pump Contractor Other <br />B Concrete Pedestal Dimensions: Width ft Length It Thick in Christy Box Stove Pipe <br />PUMP Submersibles. 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 />MINIMUM 47_8- HOUR <br />�ADVA E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED /%G'wYw— TITLE Authorized Agent DATE 12/05/2018 <br />EP <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS <br />TMENT U E O LY <br />Date <br />Date <br />Date <br />Date <br />(n <br />LVED <br />6 2013 <br />"IAL HEAL:I-H <br />'NIENT <br />Area Employee ID#� <br />PECIAL Well Permit 111111 <br />WAIVER Received <br />Constructed Well Depth ft <br />I 12 I—XIII. 0 <br />I�7!jR���%�%i��r�flTiZ�[�i•7/���`���_��_��1%��rl=�c�\/ <br />F.2► VA. <br />■ <br />II <br />■ i <br />EHD 43-06 revised 4114/18 <br />WELL /PUMP PERMIT <br />1 <br />