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Jul, 13. 2017 10:33AM Canepa & Sons No, 9007 P. 2 WELL UESTRUCTION PERMIT PUBLIC WATER SYSTEM Q Yea 0 No SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1860 East Hazelton Avenue • STOCKTON CA 86206.6292 - (209) 469-3420 NLJN-KF;PVNDABLE PERMIT CALL 209 953.7697 FOR INSPEGTION5 EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESa STERLZNG STREET CITYIZ,D WOOD13BIDGE, CA 95250 CROSS STREET STERLING 6 TRIcLO APN 015-071-29 PARCEL SIZE - 04 LAND UaE APPLICATION R OWNER SAN JOAQUIN COUNTY PHONE_ OWNER ADDRESS _ CITYISTATPJZIP STOCKTON, CA CONTRACTOR CANEPA AND SONS, INC. PHONE 12051 532-1136 CONTRACTOR ADDRESS 14304 CUESTA COURT CITYISTATEIZIP SONORA, CA 95370 C-57 WELL DRILLING LICENEC NUMBER 425749 EXPIRATION DATE 7/31/16 PERFORATION CONTRACTOR_ PHONI; 1916061-5224 PERFORATION CONTRACTOR ADDRESS 12302 ANDES AVENUE CITYISTATE21P BAKER5ETBLD, CA 93312 ❑ C-57 Well Drilling VU- C -b,4- L-1 f 6 &,,"> License Number 01- I-"t'� "4,PF, Bureau of Alcohol, Tobacco ana Flieerme • Users of High Explosives c{c License Number ,p-9A-oeT-Is-aY,�a..'al'� piralian Dela / 1115 CHP Hazardous Materlal Transportation for Explosives License Number Explrallon Dale Sen Joaquin Counly Sherltr-CoronOr Explosives Application and Permit License Number Expiration Date California Occupational Seely Health - Blaster License Number 9201 Explration Date REAS011 FOR DpsTRucnDN D Dry ❑ Replacement Well [] Caved In ❑ Pit Well El Inacllve ❑ Tort Hole Delecled / Suspected Well Water Contaminanl(e) Adlacehl property with contamination (Address) Known Soll / Waler contaminants at adjacent properly xISTI O WELL CON*Tgur-noN DETAI 9 11 Open Bottom 0 Gravel Pack ❑ Unaged ❑ Other Well Log copy attached ® Yea ❑ No Grout Seal ❑ No ® Yes 60 H below ground surface (Dgs) Hole Dlamoter Inches Well Conductor Casing El Yes ❑ No Depth of Conductor Casing 60 It bga Diameter of Conductor Casing 16 inches Well Casing Diameter 10 inchos Total Depth 38F It Depth to Water It Depth o(Cdsing 386 R bgs DMRUC71ON SPECIFICATION .t Sealing Material from 0 fl bga to -569 f1 bgs Flller Materlal liLUAEiY from n Dgs to -3..8$ It bg= Well casing to be 06r/oratod by one of the folipwinelmethad 1►om�Z'9'V H bgs [a Z:lgaf n D ❑1 Mills Knife Number of cuts every (I and / or U. Explosives ❑ Detonating cord ❑ with projectiles every A ❑ withow projectile �9 )elona(ing cord and boosters ❑ with projectiles every ft ❑ without projectile 11 other Sealing Material Neal Cement (9416 bag16-6 gal wafer) end Cemen{ 11 sack mix 17 gal wafer Benlonlle Pellets Bentonlla (20% solids) nulaclurer Spec % selids_ % Name Specs on File Specs Submitted Placement Method Pumps Free Fall Other Seal Completion Complete wllh Mushroom Cap H bgs Complele to Exisfing Surface Pad , nCncoT 'EKnhT IHAI I HAVt PIIaPAHED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS, CONTRACTORS ,.... , .:...... L..... RECE ...j...... . cyp,Ty.70A NV{tE.A''""'"..5........i._..i._... HFAI-� Application Accepted By! Destruction Insppe�cliioon.�By COMMENTS 612.31 R ADVANCE NOTICE REQUIRED FOR INSPRCTIONS D E P A R T E N T U S E O L Y r Date Dale Amount I Date Remitted .% ly MIL Area ' � Employee 10# EMD43-DB O-' 4 089671 -_J0 L`% -b 10l5r07 Received Time Jul.13. 2017 10:44AM No.1877 Invoice it Well IDA ill WELL DESTRUCTION PERMIT