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I WELL/PUMP PERMIT SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 13613 West Byron Road CITY/ZIP Tracy, 95304 CROSS STREET S Lammers Road APN 209-260-20 PARCEL SIZE 101? LAND USE APPLICATION # OWNER NAME Maninder Sandhu, Tarlochan & Gurbux & Ranjit & Nirmaljik Kaler PHONE 510-484-6697 OWNER ADDRESS 3972 West Durham Road CITY/STATE/ZIP Tracy, CA 95304 CONTRACTOR V&W Drilling PHONE 209-369-9600 CONTRACTOR ADDRESS A 1133 Blackhurst Drive — � �CIITY/STATE/ZIP Galt, CA 95632 SUBCONTRACTOR /' { ,() ec(,G'� i /_ rpm YKf 4 e t i 11A ,u, I w � 1'. PHONE � �D Z I � ~ & i/� ��j� SUBCONTRACTOR ADDRESS L) �. YVll� "I, "d `U`c)0 If ✓ CITY/STATE/ZIP Wrgt ' /QcYa,wN Af.' I'A- t S LICENSE B C-57 C-61 ❑ D-09 F -i Other NUMBER 7 2 0 9 0 4 EXPIRATION DATE 4/30/2024 DOMESTIC WELL SAMPLING: ❑ General Mineral/Coliform Bacteria (4391) ❑ Dibromochloropropane (4392) ❑ Arsenic (4393) INTENDED USE ❑ Domestic/Private 7 Irrigation/Agricultural Industrial -, Water Quality Monitoring ® Soil Sampling/Characterization ❑ Public Water System If different from Owner: Water System Name Contact Name or Phone Number TYPE OF WORK a New Well Replacement Well I1 Well Alteration/Modification Other ❑ Monitoring Well(s) # of wells X Soil Boring(s) 1 # of borings Geotechnical # of borings ❑ Out -Of -Service Well ❑ Out -Of -Service Well Renewal -: Cross -Connection Repair ❑ New Pump ❑ Pump Replacement ❑ Pump Repair -1 Raise Well Casing WELL CONSTRUCTION Drilling Method Mud Rotary ❑ Air Rotary x Auger ❑ Cable Tool Push Point 1 1 Other Proposed Well Depth LLS ft Excavation in diameter Open Bottom _i Gravel Pack/Gravel Size in diameter Conductor Casing in diameter / Conductor Casing Depth ft Well Casing Diameter in Thickness/Gauge/ASTM Sched Steel Plastic Stainless Steel ❑ Other Grout Seal Depth 4S ft -1101eat Cement (94 /b bag/5-10 gal water) !7 Sand Cement sack mix/7 gal water Bentonite (20% solids) ❑ Other Grout Placement Method Pumped -/-Free Fall I-1 Other Retardant / Accelerator (name) PEDESTAL Installed By Driller ❑ Pump Contractor ❑ Other Concrete Pedestal ❑Dimensions: Width ft Length ft Thick in Christy Box ❑ Stove Pipe PUMP Submersible . -i, Turbine Other HP Pump Set ft Standing Water Lev Plot Plan Requirements: Attach a plot plan with the exact location of water well with respect to the follow in jte s U Coordinates, property lines, adjoining properties, water bodies or courses, drainage pattern, roads, existing potential sources of contamination, sewers or private disposal systems. Include distance from two property linef 4tN Agriculture, Industrial well, provide location of any water wells or surface water within 200' radius of proposed well. MINIM( N1 24 1101 R -kDN %%( III \0I I('F RVOT, IRED I.OR I\SPIJ I IONS - I'LE kSF CALL (209) 953-7697 DEPARTMENT USE ONLY �+ Application Accepted By � Date Z Z ZZ Area S` �� Employee ID# A j Grout Inspection By Date ❑ SPECIAL Well Permit Pump Inspection By Date ❑ WAIVER Received Soil Boring Inspection ByDate �� vL Constructed Well Depth ft COMMENTS :If LOTAle fs '4, Man -o n nr is Ort T m D v 0 m m to cn S �Iv NT 7a,-( PE Sc Received Check#/ Codes Infoas Amount Date Permit/ Invoice # Well ID# Remitted ervice Re uest # 7 so 6 EHD043.06 10/25/2021 yy / l�l/ Q (� 1 Page I r'_ Well / Pump Permit ��0 2Z