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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 /> JOB ADDRESS ClrrlLP <br /> 717 W. Atherton Drive Manteca ! 95337 rn <br /> ¢ <br /> CROSS STREET Lakeside Avenue APN day 0a ' y e1 PARCEL SIZE ' 01 �J LAND USE APPLICATION # A <br /> ER NAME Valencia Place Apartments, LLC - Contact: Albert Boyce PHONE 209.234.4014 <br /> OWN ADDRESS P.O. Box 1870 CITY/STATE(LIP Manteca, CA 95336 <br /> CONTRAC V & W Drilling - Contact: Karli Stroing PHONE 209.469.7700 <br /> CONTRACTOR REBS 1 133 Blackhurst Drive CITYISTATEMp Galt, CA 95632 > <br /> n <br /> SUBCONTRACTORIC SULTANT Condor Eardi - Contact: Ron Skaggs, Principal Engineer, CA GE2295 PHONE 209.938. 1040 0 <br /> 7 <br /> SUBCONTRACTOR/CONSUL ANT ADDRESS 188 Frank West Circle Suite I CITYISTATE/LP Stockton, CA 95206 D <br /> 720904 EXPIRATION DATE 04/30/2022 <br /> LICENSE }( C-57 1 D-09 Other NUMBER A <br /> BILLING PARTY: 0 ER CONTRACTOR SUBCONTRACTOR/CONSULTANT .01 <br /> DOMESTIC WELL SAMPLING: Gen al Mineral/Coliform Bacteria (4391 ) Dibromochloropropane (4392) Ar epic (4393) <br /> INTENDED USE Domestic/Privatenig ation/Agriculturat Industrial Water Quality Monitoring Soil mpling/Characterization a <br /> Public Water System <br /> IfdRerent from Omer Water System Name Contac ame or Phone Number <br /> TYPE OF WORK New Well Replacem1 t Well Well Alteration/Modification Other <br /> MonitoringWell(s) # wells SoilBoring(s) # 0r00" "�S Geotechnical I aothangs <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross nnection Repair <br /> New Pump Pump Replacemen Pump Repair Ralrj Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br /> Proposed Well Depth 20 It Excavation 4.5 in diameter Open ottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / ductor Casing Depth ft <br /> Well Casing Diameter . in Thickness/Gauge/ASTM Schad S el Plastic Stainless Steel Other <br /> Grout Seal Depth full depth ft x Neat Cement (94 lb be 10 gal Water) Sand Cement sack mixl7 gal water <br /> Bentonite (20% solids) Other <br /> Grout Placement Method Pumped Free Fall X Other Tremie Retardant / Accelerator (name) L � <br /> PEDESTAL Installed By Driller Pump Contractor Othef <br /> Concrete Pedestal Dimensions: Width ft Lepglh ft Thick in Christy Box Stove Pipe l <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 \, I <br /> WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRAC ORS STATE LICENAND THAT I AM IN COMPLIANCE WITH ALLWORKERS COMPENSATION LAWS,MINI OUR 6 TI E SQUIRED FOR INS - PLEASE CALL (209) 953-7697kSIGNED TITLEProject DATE 05/03/21 <br /> eAlr <br /> jig T <br /> �Fi�NT <br /> qr 49 Fo <br /> ° Q�, < �?� <br /> e FART 0 <br /> r <br /> l DEPARTMENT USE ONLY <br /> AppiicgzonAccepted By �`� Date I Area Ins1 ✓i�cti Employee ID# V <br /> /rout Inspection By Date SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> l Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Check## Amount Dae Permit/ Invoice # Well ID# <br /> Codes Info aoCash Remitted ervlce R s # <br /> 374 1 sv ysb 2 <br /> EHD 4506 6n 1!1019 ' zi1y 'D&50 VIELL !PUMP PERMIT <br />