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' 20246 WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205-6232 - (209) 468-3420 <br />NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />Jos ADDRESS 26i9 F. FRp.NrH ramp R-1 CITY/ZIP MANTECA CA 95336 <br />CROSS STREET LODUCA DR. APN 177-47-020 PARCEL SIZE 1 . 5 a -AND USE APPLICATION # <br />OWNER NAME RON LEANDRO PHONE 209 922 <br />OWNER ADDRESS 2638 E. FRENCH CAMP R n_ <br />3194 <br />CITY/STATE2iP FRENCH CAMP CA 95336 <br />CONTRACTOR Delta PIMP ----Sl -MCKTON ARMATURE R MOTOR WORKS x._209-466—AF2 <br />CONTRACTOR ADDRESS 646 S. California Street <br />CITY/STATE/ZIPStOCktOn. CA 95203 <br />SUBCONTRACTOR <br />SUBCONTRACTOR ADDRESS <br />CITY/STATE/ZfP <br />PHONE <br />[LICENSE 0 C-57 X C-61 0 D-09 0 Other NUMBER 724778 EXPIRATIONDATE 08/1% <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township Range Section <br />INTENDED USE 0. Domestic/Private CCIkfigation/Agricultural 0 Industrial 0 Water Quality Monitoring 0 Soil Sampling/Characterization <br />C Public Water System <br />If different from Owner Yvater Systern Name GontactName or 11hone um er <br />TYPE OF WORK 0 New Well 0 Replacement Well 0 Well Alteration/Modification 0 Other <br />0 Monitoring Weil(s) # Of wells 0 Soll Sorin s # of borings # <br />gO 0 Geotechnical e ■ <br />0 Out -Of -Service ry <br />ell 0 Out -Of -Service Well Renewal 0 Cross -Connection Repair p /'► <br />❑ New Pump Pump Replacement 0 Pump Repair 0 Raise Well Casing <br />REcEl� ; j <br />TR <br />WELL CONSTRUCTION Drilling e C <br />Drilling Method ❑ Mud Rotary 0 Air Rotary 0 Auger ❑ Cable Toot 0 Push Point 0 Other APR 2 6 201 <br />Proposed Well Depthft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Grave] Size�OAA bYl4i eter <br />0 Conductor Casing in diameter / Conductor Casing Depth ft ON "�u1V <br />Well Casing Diameter in Thickness/Gauge/ASTM Sched HEALT MEN7AL <br />0 Steel 0 Plastic 0 Stainless Steel 0 Other H �EPAR7MEN <br />Grout Seat Depth ft 0 Neat Cement (94 lb bag/5.10 gal water) 0 Sand Cement <br />sack mixR gal water <br />0 Bentonite (20% solids) 0 Other <br />Grout Placement Method ❑ Pumped 0 Free Fail 0 Other 0 Retardant / Accelerator (namel <br />PEDESTAL installed By C Driller 0 Pump Contractor 0 Other <br />C Concrete Pedestal Dimensions: Width ft Length ft Thick in 0 Christy Box 0 Stove Pipe <br />ubmersibte0 Turbine 0 Other HP 2— Pump Seth ft Standing Water Level —32. 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 CALIF NIA CONTRACTORS STATE LICENSE BOARD AND THAT .I AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSA 10 S. <br />MINIM HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />SIGNED TITLE CEO <br />DATE4/19/2018 <br />Application Accepted By <br />Grout Inspection By <br />Pump Inspection By <br />Datei5W! % <br />Date <br />Date elve <br />-00Boring Inspection By Date <br />COMMENTS Constructed Well Depth ft <br />rn <br />Im <br />v <br />M <br />W <br />y <br />Employee ID# <br />Aew <br />SPE IAL WPermit <br />Per t <br />WAIVER Rec ' d <br />PE <br />Date rermv - <br />Service Reuest # Invoice # Well ID# <br />3a`�Z <br />EMD 4306 <br />8704108 <br />WELL /PUMP PERMIT <br />