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Page 2 <br /> "[Click here and type site nae <br /> m <br /> [Click here-and type facilityTaddress] <br /> ® Please note: All groundwater displaced to the surface during grout installation shall be pumped <br /> out of the excavation and containerized for proper disposal and to allow for EHD inspection and <br /> verification that the well was properly destroyed. <br /> After the EHD has approved the well destruction scope of work proposal, you may submit an EHD Well <br /> and Boring Permit Application form and the appropriate fees for each parcel. The permit fee for the <br /> destruction of each well is $122, along with a $366 Inspection.Activity fee. A review of the site records <br /> indicates that(insert one.of the following) <br /> "[Click here & type #of MW]"currently^are installed at this site. A permitting fee of <br /> $"[Click here &type fee amount 366 )]''; ill be required for the <br /> well destruction applications. <br /> (use for nested wells) <br /> "[Click here & type # of. MW]" 'casings are currently installed in <br /> "[Click here & type # of bore holes]" boreholes. Each nested well is considered as one well for <br /> permitting _and fee purposes_ _ A permitting fee of $ <br /> '[Click here & type fee_amount (# of MW x122 + 366 )]" gib will be required for the <br /> well destruction applications. <br /> f} 5��z,,,�-c.. w�11�.t3�i✓L�y,� vPivk� F �P 1�c�t`a cv M.0 s f----ire.-su la���-�{-�� � euc�t s'Qja�.�-L. <br /> �Q,VCxSL,c <br /> If you have any questions, please contact [Click here&type your namewand phone#]" . <br /> {Click here &type your name REHS Adrienne Ellsaesser, REHS <br /> Registered Environmental Health Specialist Acting Program Coordinator <br /> c: Mr. James L. Barton, CVRWQCB <br /> Mr. Mark Owens, SWRCB-CUF <br /> RP <br /> r <br />