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WELL DESTRUCTION(ABANDONMENT)FORM <br /> DATE September 28,2001,TIME-15 00 hours ,METHOD Pressure Grout <br /> PROJECT NUMBER–R603 , ADDRESS 6425 PACIFIC AVENUE STOCKTON CA <br /> WELL ID## MW-10. WELL USE GROUNDWATER MONITORING, VAPOR EXTRACTION <br /> WELL OWNER WICKLAND PROPERTIES PROPERTY OWNER LINCOLN PROPERTIES <br /> WELL ADDRESS 6425 PACIFIC AVENUE,STOCKTON,CA <br /> OVERSIGHT AGENCY SAN JOA UIN COUNTY PUBLIC HEALTH SERVICES PHS-EHD <br /> DRILLING CONTRACTOR WOODWARD DRILLING INC. C57 0710079 <br /> WELL CONDITION <br /> TRAFFIC BOX Well inside of 12" PVC conductor <br /> • CASING TYPE PVC, SIZE—4 INCH DEPTH 65 FEET <br /> DTW NM ,DEPTH TO BOTTOM CASING NM OBSTRUCTIONS <br /> DESTRUCTION METHOD <br /> PRESSURE GROUT Pressure grout with neat cement,place expandable packer in casing and pressure <br /> with grout pump for 30 seconds,no drop in pressure <br /> OVER-BORE <br /> COMMENTS–Cut off conductor and well casing six inches above UST excavation grade(approximately 3 <br /> 1/2 feet below surface Place form (36"diameter by 24 inches long)around conductor and fill wk;� gement <br /> to form cap <br /> Western Geo-Engineers, 9-28-2001 Woodward Drilling, Inc, 9-28-01 <br /> CONSULTANT, DATE DRILLER, DATE <br /> PRINT NAME GEORGE L CONVERSE <br /> • <br />