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X673 ~"AIW <br /> ^ WELL/PUMP PERMIT <br /> SAN JOAQUIN OUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFU ABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br /> JOB ADDRESS East Woodward&Atherton Drive Z - CITY/ZIP Manteca,CA m <br /> D <br /> CROSS STREET APN� f'J'l/,7^J'PARCEL SIZE&JrLAND USE APPLICATION# S <br /> m <br /> OWNER NAME City of Manteca PHONE m <br /> OWNER ADDRESS 1154 S.Union Road CITY/STATE/LP Manteca,CA 95337 <br /> CONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> CONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/ZIP Clovis,California 93612 <br /> SUBCONTRACTOR Krazan&Associates,Inc. PHONE 559.348.2200 <br /> SUBCONTRACTOR ADDRESS 215 W.Dakota Avenue CITY/STATE/Z1P Clovis,California 93612 <br /> LICENSE VC-57 I I C-61 u D-09 I Other NUMBER 499908 EXPIRATION DATE 10'31.2018 <br /> DOMESTIC WELL SAMPLING:n General Mineral/Coliform Bacteria(4391)'I Dibromochloropropane(4392) �Arsenic(4393) <br /> INTENDED USE F,Domestic/Private -Irrigation/Agricultural nindustrial - Water Quality Monitoring F Soil 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 I I Replacement Well I I Well Alteration/Modification I I Other <br /> F MonitoringWells #of wells ❑Soil Borin s u of borings 4 s of borings <br /> O gO fi Geotechnical <br /> Out-Of-Service Well i Out-Of-Service Well Renewal -!Cross-Connection Repair (17770Teet) <br /> New Pum i Pump Replacement i Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method I Mud Rotary D Air Rotary Auger (I Cable Tool FI Push Point I I Other <br /> Proposed Well Depth ft Excavation in diameter L Open Bottom i Gravel Pack/Gravel Size in diameter <br /> u Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter_in Thickness/Gauge/ASTM Sched L Steel Plastic ❑Stainless Steel Other <br /> Grout Seal Depth it V Neat Cement(94 Ib bag/5-10 gal water) i!Sand Cement sack mix/7 gal water <br /> ❑Bentonite(20%solids) n Other <br /> Grout Placement Method I Pumped o Free Fall ❑Other 1 Retardant/Accelerator(name) <br /> PEDESTAL Installed By Driller F'Pump Contractor ❑ Other <br /> Concrete Pedestal❑Dimensions:Width It Length ft Thick in a Christy Box Stove Pipe <br /> PUMP G Submersible[)Turbine I i 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 48 HOU DVA NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED TITLE Managing Engineer DATE 10/15118 <br /> �yM <br /> CFoVNT <br /> 8 Fp <br /> nL <br /> ?018 <br /> T MEH�N�Y <br /> TMFHP <br /> tyR MENT US O LY <br /> ARMVApplication Accepted By / Dat [l/ Area Employee ID# <br /> Grout Inspection By '( Date_ _ ._ SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date I Constructed Well Depth ft <br /> COMMENTS <br /> PE SC ReceivedChe Amount Permit/ <br /> odes Info B Cash Remitted <br /> Date Seryice Re st# Invoice# Well ID# <br /> IOU mol/ <br /> EHD 43-06--d 4/14/18 WELL/PUMP PERMIT <br />