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. 1 <br /> WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232 (209)468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> w <br /> JOB ADDRESS 2064 N Union Road CITy/ZIP Manteca,CA m <br /> D <br /> CROSS STREET W Lathrop Road APN O "0,9OO/1 PARCEL SIZE 1, aC LAND USE APPLICATION# p <br /> OWNER NAME Manteca 18 LLC PHONE (310)991-6560 y <br /> OWNER ADDRESS 2355 Westwood Boulevard,Suite 410 cTYISTATE/ZIP Los Angeles,CA 90064 <br /> CONTRACTOR Moore Twining Associates Inc. PHONE 559-268-7021 <br /> CONTRACTOR ADDRESS 2527 Fresno Street crrrl8TAwmP Fresno,CA <br /> SUBCONTRACTOR/CONSULTANT Same as Contractor PHONE (559)262-7021 <br /> SUBCONTRACTORICONSULTANTADDRESS Same as Contractor CITYISTATE/ZIP <br /> LICENSE X C-57 C-61 D-09 Other NUMBER C506159 EXPIRATION DATE 02/28/2023 <br /> BILLING PARTY: OWNER X CONTRACTOR 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) n of borings x Geotechnical 11 #of bor ngs <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 x Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br /> Proposed Well Depth 4-50 it Excavation 6-8 inch in diameter Open Bottom Gravel Pack/Gravel Size NA in diameter <br /> Conductor Casing NA in diameter / Conductor Casing Depth NA it <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br /> Grout Seal Depth FUII depth it X Neat Cement(94 lb bag/5-10 gal water) Sand Cement sack mW7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method X Pumped X Free Fall Other Retardant/Accelerator(name) <br /> PEDESTAL NA Installed By Driller Pump Contractor Other <br /> Concrete Pedestal Dimensions:Width it Length ft Thick in Christy Box Stove Pipe <br /> PuMP NA Submersible Turbine Other HP Pump Set it Standing Water Level it <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 COMPENSATIO LAW . <br /> MINIMUM 4 UR D OTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Division Manager DATE 10/16/2021 <br /> YNjFN <br /> S(!e)%tlachnie6t1orl3c1rirg IIIo ato s C r <br /> l SFO <br /> q 5 ?p21 <br /> Nc <br /> ;Po <br /> RT 4NTY <br /> MINT <br /> DEPARTMENT USE ONLY t ,,,,yy�� <br /> Application Accepted By ' Date �0 a��� Area 3 frr4"+�EmployeelD#--AE1A2 <br /> Grout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date yam- WAIVER Received <br /> Soil Boring Insp coon y Date ) Construc"d Well Depth ft <br /> COMMENTS . B C( y1?7 P /iS jtremnle <br /> PE SC Received Check#/ Amount Date Permit/ Invoice# Well ID# <br /> Codes Info ash Remitted S rvice Re uest# <br /> 437d ;0 6 Q 15, 2-1001 <br /> EHD43-06 6111/2019 � � WELL(PUMP PERMIT <br />