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r <br /> WELL DESTRUCTION PERMIT <br /> PuBw WATER SYSTEM El Yes Xw <br /> SAN JOAauw Couwry EtAnnawwrAL RmTN DrPAR=EIcT 600 E MAIN STREET•STOCKTON CA 96202•(209)686�4=D <br /> NON-ReFuNDABLE PERMIT CALL 209 963-7697 FOR INsi ECTIONS EXPIRES I YEAR FROM DATE ISSUED f <br /> JOB Ao„.fe 2448 Kettleman Road Lodi 95240 . rn <br /> Chap sTR[ET Sacramento Road N 058-140-01ANcu su E._68 L ino u g APPucATm <br /> owNER Tesoro Sierra Properties LLC -_ Q u d}t! <br /> OwrteltAoorreas 300 oncord Plaza Dr. i&rATuw San AntOnio�TX 7821fi — z ""` <br /> CoN1RAcroR <br /> Q '11' mow925- 13-5800 A �"• <br /> CO...TcRA11M 950 Howe Road 1STAT'EIDP Martinez,C. 94553 N <br /> C47 waLL D11 Luma LICENSE NuraER 485165 PIRATION DATE 0112D 10 <br /> PERFO"Mcm coormetoR <br /> PRIWORATION CONTRACMR AbnhEae ISTATEZIP <br /> CI G67 Wall DrillingNumber Expiration Date <br /> Bureau or AlcohoL Tobacco and Fh emrtm-ueart or High Explosive: Lkan o Number E3pkation Dais <br /> CHP Hazardous Material Tranoporlaean for Explosives Llas Number Expiration Date <br /> Sen Joaquin County Shwiff-Coroner Eq losivee Applicsdon and Pamdt Licari a Number E>phatlon Dine <br /> Cal6otda 0=Vag nal Swett Health-Blaster Lken a Number Exphalluh Data <br /> p Dry 0 Reptacurrie d WM6 0 Caved In O Ph Wee PK Nedkve 0 Test H" <br /> Deteged 1 Suspected Well Hitter Cantwirionq■ <br /> A4W.aW wopeft vrilh contalmili6m(Addmu — <br /> Knawn Soo I water contamhwnts at a*www pruP8rtY_z_-- <br /> DETAM <br /> a DPW am" 0 GravelPm* a urm d X other PVC Casing_- <br /> - <br /> vr a Loy copy at wW X Yes a No Groat Sed a No X Yes 3Z_0 below Around aurhras(bps) Hale Dlamatarimdtes <br /> W44 Coodudw Casing 13 Yea X No Depth of Conductor Coming tt bps DlaMaer arConductor Cooft Inches <br /> Wan Cptny DUMetrr_,2_hhces T■M Depth_60 ft Depth to water 50 n Depth of Casing 60 it bps <br /> Seating Matari i kom 2 a bps to 60 0 bps FIDer Material Irmo rt bps to A bps <br /> Well eaisho to be Age by ane of do fbi ako Malbad■: fmm rt We to K bps <br /> a hpib Knft Number d cite every R and I ar <br /> G Explosive■a Detotpdinp amd a wrote pro)■o61■s every rt 0 WrAx i prolatlRs <br /> E3 Deimhating cad and boostars 13 with projectiles every rt a mahme pro*tae <br /> a Other <br /> Saslitp Materiel Neat Csmertt ffi bop/6a paf wehrr} Sand Cement wrote mbr J7 psi water Bwtbanito Pallet■ <br /> Bwfte t■{2A%solidsSpec%to6ds % Name Space on Fite Spece Sut mM@d <br /> in <br /> Plaefent Wthal ' ' F -� obac pressure arOUt <br /> Seal Compatim ' Complete W&Mushroom Cap 2' R box Corr"h to Fxb ttp Sudsc■Pad <br /> 1 HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT WORK WALL BE DONE IN ACCORDANCE WITH SAN <br /> JpAQUW COUNTY ORDINANCES.STATE LAV0.AND RULER AND REGULATIC NS: I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CuRRENT-AND ACTIVE NRTN THE CALIFORNIA CONTRACTORS STATE UCE E BOARD AND THAT I AAI IN COMPLIANCE WITH ALL <br /> WORKERS COMPENSATION LAWS. <br /> I UM 2 O R ADVA NOTICE REQ IRED FOR INSPECTIONS <br /> Coormcra"SIGNATURE <br /> l - <br /> 7. <br /> L <br /> -- . <br /> I t{y - - �� <br /> DEPARTMENT USE ONLY _ <br /> AppNption Accepted By Date — <br /> Deseudion Ineperbsn By Date Empbyse IDG <br /> COMMENTS <br /> Cha eSCTo Recey CCash RaMICad .haclaw A .R Wel9 Pomrd Invoke* well IDf <br /> So O oA0V Ser <br /> FJiO p-M WELL DESTRUCTION PERMIT <br /> low? <br />