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t , <br /> DC-GBO145 WELL/PUMP PERMIT _ _ <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE-STOCKTON CA 95205-6232(2091468-3420 <br /> NON-REFUNDABLE PERMIT www.sjgov.org/ehd EXPIRES 1 YEAR FROM DATE ISSUED <br /> to <br /> JOB ADDRESS 435 N Walnut Ave CITY21P Manteca,CA.95336 <br /> a <br /> CROSS STREET W Alameda St APN at S 9 Od L] PARCEL SIZE•LAND USE APPLICATION# A <br /> m <br /> OWNER NAME Pacific Gas&Electric (Walther Tigerino) PHONE 209-857-0181 m <br /> OWNER ADDRESS 12840 Bill Clark Way CITY/STATE/ZIP Aubum.CA.95602 <br /> CONTRACTOR Gregory Drilling Inc. PHONE 425-869-2372 <br /> CONTRACTOR ADDRESS 14112 452nd Ave SE CITYISTATE21P North Bend,WA 98045 <br /> SUBCONTRACTOR/CONSULTANT PHONE <br /> SUBCONTRACTOR/CONSULTANT ADDRESS CITY/STATE/ZIP <br /> LICENSE X C-57 ❑"1 ❑D-09 ❑Other NUMBER 1007649 EXPIRATION DATE 1-31-2021 <br /> BILLING PARTY: ❑OWNER X CONTRACTOR ❑ SUBCONTRACTOR/CONSULTANT <br /> DOMEsnc WELL SAMPLING:0 General Mineral/Coliform Bacteria(4391)❑Dibromochloropropane(4392)0 Arsenic(4393) <br /> INTENDED USE ❑Domestic/Private ❑Inigation/Agricultural X 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 X Other Cathodic Protection <br /> ❑Monitoring Well(s) #of wells ❑Soil Boring(s) #of borings I Geotechnical #of bonngs <br /> ❑Out-Of-Service Well ❑Out-Of-Service Well Renewal 0 Cross-Connection Repair <br /> ❑New Pump ❑Pump Replacement ❑Pump Repair ❑Raise Well Casing <br /> WELL CONSTRUCTION <br /> Drilling Method ❑Mud Rotary ❑Air Rotary ❑Auger ❑Cable Tool ❑Push Point X Other Sonic <br /> Proposed Well Depth 200 ft Excavation 8 in diameter ❑Open Bottom ❑Gravel Pack/Gravel Size in diameter <br /> �7 Conductor Casing in diameter / Conductor Casing Depth ft <br /> Well Casing Diameter 2 in Thickness/Gauge/ASTM Schad ❑Steel X Plastic ❑Stainless Steel ❑Other <br /> Grout S,a�epth�f ft X Neat Cement(94 Ib bag/5-10 gal water) ❑Sand Cement sack mixf7 gal water <br /> p�Pk 1 ps 3�Z D Bentonite(20%solids) ❑Other <br /> Grout Placement Method X Pumped ❑Free Fall ❑Other 0 Retardant/Accelerator(name) <br /> PEDESTAL Installed By ❑Driller ❑Pump Contractor ❑ Other <br /> ❑Concrete Pedestal❑Dimensions:Width ft Length ft Thick in ❑Christy Box ❑Stove Pipe <br /> PUMP 0 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 4488 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> SIGNED_ /`C//�� TITLE Vice President DATE 3/12/2020 <br /> INT <br /> FD <br /> ?020 <br /> A <br /> E E NTqtVT <br /> 1 Y <br /> TMENT <br /> D E P A R T8 to itl4�CamSca nor <br /> Application Accepted By Date ZO Area .S /�tiN��`Employee IN. <br /> Grout Inspection By Date ❑ SPECIAL Well Permit <br /> Pump Inspection By Date ❑ WAIVER Received ^ <br /> Soil Boring Inspection By Date Constructed W 11 D pth ft <br /> COMMENTS— <br /> .� � e CL2 d Sof (9H-96� <br /> PE SC Received Che Amount Date Permit/ Invoice# Well ID# E74}S <br /> Codes Info as Remitted ice Re uest# <br /> 37� l8i Sas <br /> EH043M 6/112019 WELL/PUMP PERMIT <br />