Laserfiche WebLink
{ <br />M Mcr)all� @ bS"s(xAaks .60M <br />RVICEIVED <br />wtLL./VUM1' F'tKMI r <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 EAST HAZELTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />NON -REFUND LE PERMIT CALL 209 953-7697 <br />FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUE <br />JOB ADDR ss W. Yosemite Avenue <br />c,T,./z,p Manteca, CA 95337 <br />CROSS Swanson Road 241-300-50 <br />STREET APN <br />PARCEL SIZE LAND USE APPLICATION # <br />OWNER NAME City of Manteca <br />PHONE D <br />OWNER ADDRESS _ Ioo1 YVeSl\ ctQ\w St. <br />CITY/STATEZP ManfeCa-1 C19 g533� <br />CONTRACTOR BSK Associates <br />PHONE q2S -315 -3151 <br />CONTRACTOR ADDRESS 399 Lindbergh Ave. <br />CITY/STATE/Z!P Livermore, CA 94551 <br />SUBCONTRACTOR Exploration GeoServices Inc. <br />PHONE 408-483-9026 <br />SUBCONTRACTOR ADDRESS 1535 Industrial Ave. <br />CITY/STATE/ZIP San Jose, CA 95112 <br />LICENSE X C-57 C-61 D-09 Other <br />NUMBER 484288 ExpiRATION DATE 12/31/19 <br />DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria (4391) <br />Dibromochloropropane (4392) Arsenic (4393) <br />INTENDED USE Domestic/Private Irrigation/Agricultural Industrial Water Quality Monitoring 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) # of borings X Geotechnical 1 # of borings <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />New Pump Pump Replacement PUmD Repair _ Raise Well Casino <br />Drilling Method Mud Rotary Air Rotary X Auger Cable Tool Push Point Other <br />Pro osed Well Depth 40 " A Excavation <br />p p 8 in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />Well Casing Diameter in Thickn`es`s/Gauge/ASTM Sched Steel Plastic Stainless Steel Other <br />Grout Seal Depth ft �( Neat Cement (94 Ib bag15-10 gal water) Sand Cement sack mix/7 gal water <br />Bentonite (20%spuds) `Other Bore hole will be backfilled with cement grout using tremie methods <br />Grout Placement Method X Pumped Free Fall Other Retardant / Accelerator (name) <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length It Thick in Christy Box Stove Pipe <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 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 />MINIMUM 4/8 HOUR ADVANQE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED )� YY TITLE Staff Engineer DATE 5/24/18 <br />See Attached Site Plan <br />2 9 2018 <br />ENTAL HEALT <br />,RTNIENT <br />RE Y�FElvr <br />CjVFD <br />JUN 012018 <br />V/RO Ugly C0 <br />TH C pM Z ��Y <br />EP TMENT U E NLY <br />Application Accepted By41 Z Date Area mployee ID#A~ <br />Grout Inspection By Date I SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By 1 Date Constructed Well Depth ft <br />COMMENTS-���;,, i.►k{ ilYfjC� <br />� t®Service Request #® r. <br />EMD 43-06 revised 4/14/18 <br />WELL /PUMP PERMIT <br />