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WELL/PUMP PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205 - (209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS <br /> 2450 W Yosemite Avenue CITY/ZIP Manteca, 95337 m <br /> n <br /> CROSS STREET Swanson Road APN 241-300-70 PARCEL SIZE 13.17 LAND USE APPLICATION# A <br /> OWNER NAME City of Manteca acres PHONE 209-456-8000 N <br /> OWNERADDRESS 1001 W Center Street CITY/STATE/ZIP Manteca, CA 95337 <br /> CONTRACTOR Taber Drilling PHONE 916-371-8234 <br /> CONTRACTOR ADDRESS 536 Galveston Street CITY/STATE/ZIP W Sacramento, CA 95691 <br /> s„acoa1RAczoa BSK Associates gla IA,b, &VT y. PHONE 925-315-3151 <br /> CONSULTANT <br /> SJJBCONTAA6F0R ADDRESS 399 Lindbergh Avenute CITY/STATE/ZIP Livermore, CA 94551 <br /> TABER <br /> LICENSE C-57 C-61 D-09 Other NUMBER 969927 EXPIRATION DATE 02/29/2020 <br /> DOMESTIC WELL SAMPLING: General Mineral/Coliform Bacteria(4391) Dibromochloropropane(4392)i 1 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 2 OPTS <br /> Monitoring Well(s) #of wells Soil Boring(s) 3 #of borings Geotechnical #of borings <br /> Out-Of-Service Well Out-Of-Service Well Renewal Cross-Connection Repair <br /> New Pump Pump Replacement Pump Repair Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method •Mud Rotary Air Rotary 0 Auger Cable Tool Push Point Other CPT <br /> Proposed Well Depth ft Excavation in diameter Open Bottom Gravel Pack/Gravel Size in diameter <br /> Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter 3-6 in Thickness/Gauge/ASTM Schad Steel Plastic Stainless Steel Other <br /> Grout Seal Depth 20 - 75 ft *Neat Cement(94 Ib bag/5-10 gal water) Sand Cement sack mix/7 gal water <br /> Bentonite(20%solids) Other <br /> Grout Placement Method OPumped Free Fall • Other Tremie 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 /> MI 8 DVANCE NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL(209) 953-7697 <br /> SIGNED TITLE V/P Exploration Coordinator DATE 06.20.2019 <br /> SA )Al2UWMM)L <br /> ENVIRONMENTAL <br /> HEALTH :)E1W,7NE7T­ <br /> TMENT U E/1O LY <br /> Application Accepted By Date ' V Area Employee ID# <br /> Grout Inspection By Date I SPECIAL Well Permit <br /> Pump Inspection By Date WAIVER Received <br /> Soil Boring Inspection By Date O Constructed Well Depth ft <br /> COMMENTS <br /> PE SC Received Amount Date Permit/ Invoice# Well ID# <br /> Rodes Inf Cash Remitted f Service Re 9uest# <br /> Z <br /> EHD 43-06 revised 4/14/18 WELL/PUMP PERMIT <br />