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9210 T/Ag <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT GALL (ZU9)'J53-75y7 FOR INSPECTIONS <br />tAPIKtb l TEAR FROM UATE ISSUEL <br />JOB ADDRESS <br />26850 N Lower Sacramento Rd <br />CiTY/LP <br />Galt, CA 95632 <br />CROSS STREET <br />Llbem Rd APN 005-030-070 <br />F <br />PARCEL SIZE 70 acreSLAND USI TION # <br />OWNER NAME <br />Ventana Development Co., Inc. <br />H NE (4 8) 279-1520 ext. 7142 <br />OWNER ADDRESS <br />55 Market Street, Suite 1210 <br />CITY/STATE/ZIP <br />San Jose, 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 />LICENSE M C-57 _I C-61 I D-09 Other <br />CITY/STATE/ZIP <br />NUMBER 133783 ExPIRATION <br />DOMESTIC WELL SAMPLING: 0 General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />7/31/2020 <br />INTENDED USE D Domestic/Private ■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 0 New Well Replacement Well Well Alteration/Modification Other <br />Monitoring Well(s) # of wells Soil Boring(s) *If findings Geotechnical # of borings <br />n Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />D New Pump ❑ Pump Replacement Pump Repair Raise Well Casing <br />WELL CONSTRUCTION <br />Drilling Method ■ Mud Rotary I7 Air Rotary Auger Cable Tool Push Point ■ Other Reverse Rotary <br />Proposed Well Depth 1 150 ft Excavation 28 in diameter Open Bottom M 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" N Steel 1i Plastic Stainless Steel Other <br />Grout Seal Depth 50 It i i Neat Cement (94 Ib bag/5-10 gal water) ■ Sand Cement 10.3 sack sack mix/7 gal water <br />i Bentonite (20% solids) [1Other <br />Grout Placement Method D Pumped -1 Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller B Pump Contractor Other <br />N Concrete Pedestal ' IDimensions: Width ft Length ft Thick in Christy Box Stove Pipe <br />PUMP 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 />MINIMUM 48 HOUR ADVA E NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED. TITLE Authorized Agent DATE 12/05/2018 <br />PSA TMENT U O L <br />Application Accepted By D to twxvz <br />Grout Inspection By Date <br />Pump Inspection By Date <br />Soil Boring Inspection By Date <br />COMMENTS <br />RECEIVeo <br />OEC 12 2018 <br />'JOAQUIN CO <br />N"?ONM UN <br />LTH OEpARN7AL <br />'ED <br />R1 <br />L HEAL1-1 <br />-'NT <br />Area Employee D# VMA <br />SPECIAL Well Permit / <br />WAIVER Received <br />Constructed Well Depth ft <br />'jW 10 <br />EHD43-06 revised 4/14/18 <br />WELL /PUMP PERMIT <br />1 <br />EHD43-06 revised 4/14/18 <br />WELL /PUMP PERMIT <br />1 <br />