WP0038781 - Laserfiche WebLink

Home Browse Search

/ c WELL DESTRUCTION PERMIT PUBLIC WATER SYSTEM ❑Yes (X No SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205-6232 -(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED v, J08 ADDRESS 4005 S. Tracy Blvd. cITY21P Tracy 95377 CROSS STREET S. of VaIDICO Rd. APN 244-020-03 PARCEL SIZES- ; -AND USE APPLICATION# - , C OWNER Homestead Community Builders a0aw 1-��/.5lla�e" b`I�E�` 09-614-2974-John Rake OWNERADDRESS 2406 Merced St.//�, 4te'7f/ -5 CITY/STATE/ZIP San Leandro, CA 94577 r�cx�'/ CONTRACTOR Hennings Bras. Drilling 6o. Inc PHONE 209-545-1185 CONTRACTOR ADDRESS 1930 Ladd Rd. CITY/STATE/ZIP Modesto, CA 95356 C-57 WELL DRILLING LICENSE NUMBER 290813 EXPIRATION DATE May 31, 2020 PERFORATION CONTRACTOR n/a PHONE PERFORATION CONTRACTOR ADDRESS CITY/STATE/ZIP lit C-57 Well Drilling License Number 290813 Expiration Date 5-31-20 Bureau of Alcohol,Tobacco and Firearms-Users of High Explosives License Number Expiration Date CHP Hazardous Material Transportation for Explosives License Number Expiration Date San Joaquin County Sheriff-Coroner Explosives Application and Permit License Number Expiration Date California Occupational Safety Health-Blaster License Number Expiration Date REASON FOR DESTRUCTION ❑ Dry ❑ Replacement Well ❑ Caved In ❑ Pit Well Inactive ❑ Test Hole Detected/Suspected Well Water Contaminant(s) Adjacent property with contamination(Address) Known Soil/Water contaminants at adjacent property EXISTING WELL CONSTRUCTION DETAILS ❑ Open Bottom ❑ Gravel Pack ❑ UncaSed ❑ Other Well Log copy attached ❑ Yes IX No Grout Seal ❑ No ❑ Yes It below ground surface(bgs) Hole Diameter inches Well Conductor Casing❑ Yes ❑ No Depth of Conductor Casing ft bgs Diameter of Conductor Casing _inches Well Casing Diameter 8"Steel inches Total Depth est-150t Depth to Water It Depth of Casing est_ 150 ft bgs DESI'RUC"1'ION SPECIFICATION Sealing Material from Oftbgs to est.150 ft bgs Filler Material from ft bgs to ft bgs Well casing to be perforated by one of the following methods: n/a from ft bgs to ft bgs ❑ Mills Knife Number of cuts every ft and/or ❑ Explosives❑ Detonating Cord ❑ with projectiles every _ft ❑ without projectile P� ❑ Detonating cord and boosters 11 with projectiles every ft ❑ Without projectile ❑ Other c r Sealing Material Neat Cement(94 Ib bag/5-6 gal water) Sand Cement sack mix/7 gal water Bentonite Pellets Bentonite(20%solids)X Manufacturer Spec%solids % Name Specs on File Specs Submitted Placement Method Pumped X Free Fall Other Q Seal Completion Complete with Mushroom Cap 4 ft bgs Complete to Existing Surface Pad I 9018 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH C S. I ALSO CURRENT AND ACTIVE JOAQUIN COUNTY (WITH THE SCA CALIFORNIA CONTRACTORS STATETATE LAWS, AND RULES AND D LICENSE BOARD AND CERTIFY H1AT I AM IN COMPLIANCE LIC ty�pMFNTA�NTY WORKERS COMPENSATION LAWS. TMFNT MINIMUM 2.4 HOUR ADVANCE NOTICE R IRED FOrR INSPECTIONS CONTRACTORS SIGNATURE TITLE VP DATE 9-14-18 I 1::L4 i 1 Q- -wc�� fig Cr ISE) �'c10Aon ME:7 _ -F— DEPARTMENT USE ONVY Application Accepted By Date J Area Destruction Inspection By DateEmployee ID# COMMENTS PE Sc Received Check#/ Amount ate Permit/ Invoice# Well ID# Codes Info Cash Remitted Service Re uest# EHD 43-08 WELL DESTRUCTION PERMIT 10/5/07