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1 04 <br />f' • <br />WELL/PUMP PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 EAST HAZELTON AVENUE - STOC A 9 - 209) NNED <br />((tt <br />�Ijo t f f' <br />NUN -REFUNDABLE PERMIT <br />CALL 209 953-7697 FOR INSPECTIONS EXPIRES 7 YEAR FROM DATE ISSUED <br />920 Frewert Road <br />Well Casing Diameter 2 in Thickness/Gauge/ASTM Schad 40 Steel X Plastic Stainless Steel Other <br />Grout Seal Depth 10 ft Neat Cement (94 /b bag/5-10 gal water) Sand Cement sack mix/7 gal water <br />)e Bentonite (20% solids) Other <br />Grout Placement Method Pumped X Free Fall Other Retardant / Accelerator (name) <br />Lathrop, CA 95330 <br />JOB ADDRESS <br />J VA <br />L <br />CITY2IP <br />CROSS STREET S. Manthey Road <br />APN 191-260-22 <br />PARCEL SIZE 31 Acres LAND USE APPLICATION # <br />OWNER NAME Harvest Power <br />..% I /, ✓,- " <br />PHONE <br />6943 N Golden State Blvd. <br />-' ; <br />'el <br />rY/STATEIZIP Fresno, CA 93722 <br />OWNER ADDRESS <br />r :i�,•L.; , :- <br />7-�'�CI`i <br />CONTRACTOR Cal Pac Drilling,`,l <br />, `,a L •�'`-��' <br />'`1 �'•` PHONE 909-795-7500 <br />CONTRACTOR ADDRESS 526 W. Ave. L <br />CITY/STATE/ZIP Calimesa, CA 92320 <br />SUBCONTRACTOR <br />PHONE <br />SUBCONTRACTOR ADDRESS <br />CITY/STATE/ZIP <br />LICENSE X C-57 C-61 D-09 <br />Other <br />NUMBER 766402 EXPIRATION DATE 07/31/2017 <br />GEOGRAPHICAL INFORMATION: Coordinates X Y Township _ Range Section_ <br />NTENDED USE Domestic/Private Irrigation/Agricultural Industrial XWater.QuaNtY onitoring Soil Sampling/Characterization <br />Public Water System �811!`CA Daya Bettadapura, PE, Ph.:(949)510-8874 <br />If different from Owner Water System Name Cornacr Name or Pnone um <br />TYPE OF WORK XNew Well Replacement Well Well Alteration/Modification Other <br />/L # of borings # of borings <br />PbG' )(Monitoring Well(s) # of wells Soil Boring(s) Geotechnical <br />Out -Of -Service Well Out -Of -Service Well Renewal Cross -Connection Repair <br />New Pumo PumD ReDlacement Pumo Renair Raise Well Casinn <br />* - W 1 L <br />a�G� <br />y <br />Drilling Method Mud Rotary Air Rotary X Auger Cable Tool Push Point Other San <br />Proposed Well Depth) 5r_It Excavation 8" in diameter Open Bottom xGravel Pack/Gravel Size sized in diameter <br />Conductor Casing in diameter / Conductor Casing Depth ft <br />` <br />(r a <br />1, <br />Grd a <br />Well Casing Diameter 2 in Thickness/Gauge/ASTM Schad 40 Steel X Plastic Stainless Steel Other <br />Grout Seal Depth 10 ft Neat Cement (94 /b bag/5-10 gal water) Sand Cement sack mix/7 gal water <br />)e Bentonite (20% solids) Other <br />Grout Placement Method Pumped X Free Fall Other Retardant / Accelerator (name) <br />/+Z'il �l <br />PEDESTAL Installed By Driller Pump Contractor Other <br />Concrete Pedestal Dimensions: Width ft Length ft Thick in Christy Box Stove Pipe <br />J VA <br />L <br />PUMP Submersible Turbine Other HP Pump Set It Standing Water Level ft <br />S <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />it Olt <br />"V <br />/ `,,,�•1' <br />tp• <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 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />SIGNED TITLE President, ABI Engineering Consultants, Inc. DATE 8/30/2016 <br />�--/ <br />11 <br />?X <br />CEIVED <br />`P 0 6 2016 <br />DEPARTMENT USE ONLY <br />,,ll 2 /U7ZZ f/U <br />Application Accepted By J!/!/I6 s- .Ifd Date q � ZAArea � l Employee ID# <br />i <br />Grout Inspection By uc Date `� I3 SPECIAL Well Permit <br />Pump Inspection By Date WAIVER Received <br />Soil Boring Inspection By Date Constructed Well Depth It <br />COMMENTS <br />Codes I Info y By yy VCash� 6temitted I Date I Service Request# I Invoice# I Wall ID# <br />"MEM <br />EH D 4306 <br />4/30/12 <br />)A.2 78 <br />HEALTH <br />