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WELL/PUMP PERMIT P /* <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />.NUN-KEFUNDABLE PERMIT UALL (LUU) Ub:S-/b`J/ FOR INSPECTIONS tXNIRtS 1 YEAR FROM DATE ISSUEC <br />JOB ADDRESS 2600 W. Yosemite Ave cITY/zIP Manteca / 95337 <br />CROSS STREET Airport Way APN 24131053 PARCEL SIZE 30.53LAND USE APPLICATION # <br />OWNER NAME Great Wolf Lodge ��' ;.� �/ a tT r /un*'e Q Acres PHONE 2 <br />OWNER ADDRESS 350 N Orleans St. Suite 10000B / % D' kJ C&T � /STATE21P Cl tq16IL <br />CONTRACTOR Kleinfelder PHONE 209-948-1345 <br />CONTRACTOR ADDRESS 2001 Arch Airport Rd Suite 100 CITY/STATE/ZIP Stockton/ CA/ 95206 <br />SUBCONTRACTOR V $ W Drilling PHONE 209-469-7700 <br />SUBCONTRACTOR ADDRESS 3806 Duck Creek Dr Crrr/STATEIZro Stockton/ CA/ 95215 <br />LICENSE XC -57 -1 C-61 -1 D-09 -1 Other NUMBER 720904 EXPIRATION DATE 04/30/2018 <br />DOMEsnc WELL SAMPLING: General Mineral/Coliform Bacteria (4391) Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE -1 Domestic/Private -1 Irrigation/Agricultural fl Industrial ❑ Water Quality Monitoring roil Sampling/Characterization <br />Public Water System <br />If different from Owner: Water System Name Contact Name or Phone Number <br />TYPE OF WORK -1 New Well -1 Replacement Well 7 Well Alteration/Modification -1 Other <br />Monitoring Well(s) # of wells -1 Soil Borings) # of borings Geotechnical 3 # of borings <br />7 Out -Of -Service Well -1 Out -Of -Service Well Renewal "1 Cross -Connection RepaiL— - _ <br />Drilling Method X Mud Rotary Air Rotary Auger t Cable Tool -1 Push Point -1 Other <br />Proposed Well Depth $� , Excavation 4-6 in diameter -I Open Bottom -1 Gravel Pack/Gravel Size in diameter <br />7 Conductor Casing in diameter / Conductor Casing Depth ft 0 20 <br />Wall Casing Diameter _ in Thickness/Gauge/ASTM Schad 7 Steel :1 Plastic :1 Stainless Steel ❑ Other <br />Grout Seal Depth ft XNeat Cement (94 /b bag/5-10 gal water) -1 Sand Cement .idArsarl(rpial water <br />7 Bentonite (20% solids) -1 Other V i(fIN CC) <br />Grout Placement Method ❑ Pumped 7 Free Fall )kOther Tremie -1 Retardant / Accelerator (name) O <br />PEDESTAL Installed By ll Driller -1 Pump Contractor 7 Other <br />:1 Concrete Pedestal :]Dimensions: Width ft Length It Thick in 7 Christy Box :1 Stove Pipe <br />PUMP 7 Submersibles Turbine -1 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 />M'NIMIy/UM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED /`- 1 ;r TITLE Staff Geologist I DATE 2/1/2018 <br />'VE© <br />EIVED <br />31 2G-103 <br />ENTAL HEALTH <br />/SERVICES <br />DEPARTMENT USE ONLY <br />Application Accepted By I' I �' ✓�(Date Area 0 1"I01 ll orf Pmployee ID# X /h a [!' <br />Grout Inspection By Date Z&bL—j�11 SPECIAL Well Permit <br />Pump Inspection By L/ 9Date (� WAIVER Received <br />Soil Baring In acti�on!�y to Z w Constructed Well Depth /� ft <br />COMMENTS �� f1 S�Sg <br />PE SC Received Check#/ Amount Date <br />Codes Info By Cash Remitted <br />Permit/ Invoice # Well ID# <br />Service Request # <br />ADL IS 0 431 <br />14 PIC—b— 3 <br />EHD 4346 6101116 Gal 1 ok2 o I WELL /PUMP PERMIT <br />