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6HS •°N WdtiZ :E 0602 •9 'APA ;LU il paAI ;) <br /> WELL DESTRUCTION PERMIT <br /> PUBLIC WATER SYSTEM ❑Yes Q No <br /> SAN JOAouw COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205.6232-(2091498-3120 <br /> NON-REFUNDABLE PERMITy <br /> _ cS V <br /> _ - - = ;•:�--c ;C;Vz EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDREss 24401 N Mackville Rd y y v CITymp ACampo,CA 95220 <br /> CROs STREET J aria n t Rd APN 0 21 -1 5 0-1 3 0 PARCEl$IZEh"'y�:AND USE APPLICATION t! e <br /> OWNER Bon mis Vineyards PHONE 20-9--810-5100 <br /> OWN Edgewood r5r - CITM/STAWfZ,PLodi r CA 95240 <br /> CONTRACTOR urvi ance Drillers, IncPHONE 209-88 5 <br /> 7-0'14 <br /> PUB <br /> CONTNACTORADDRm OX CITY/$TARFIZiP Linden, CA 95236 <br /> X-5T WELL DAa1,NG Dr <br /> NUM'IBER ExPIRAT1oN DATE Ju 3 1 2 1 <br /> PERFORATION CONTRACTOR Dr Wel PHONE ^ —3 <br /> PERFORATION CONTRACTOR ADDREssPQ o x 1695 CITY/STATE/ZIP •10' 0 K �- <br /> ❑ C57 Weil ONling License Number A �y pExprati Date <br /> Bureau of Alcohol,Tobacco and Firearms-Users of High Explosives License NUmber7'CA467 334P`Expl Date <br /> CHP Hazardous Material Transportation for Explosives license Number Expiration Date <br /> San Joaquin County Sheriff-Coroner Explosives Application and Permit License Number Expiration Dale Z /1�� <br /> California Compational Safety Health-Blaster License Number Expitallon Dale /� /// A`� <br /> REASON FOR DESTRUCTION [I Dry ❑ Replacement Web El Caved In [I Pit Weil ® Inactive ❑ Test Hole C/►`F/11/itb <br /> Detected/Suspected Well Water Contaminant(s) <br /> Adjacent property with contamination(Address) Ad <br /> Known Soil/Water contaminants a:adjacent property 0 ?010 <br /> Eas9nNG WELL C:oNsTRUCTION DETAIL4 TA Open Bottom ❑ Grauel Pack ❑ Uncased ❑ Omer QU//V <br /> Wen Log copy aRaCTed El Yes Jif No Grout Seat ❑ No (3 Yes It below grand surface(bgs) Hole Diemeter F,4 0(�M6n O(fN� <br /> Wan Conductor Casing Yes $ Na Depth olConductor Ceeing it bgs Diameter alConductor Casing inch Icpq TqL <br /> Wen Casing Diameter_/inches Total Depth �� ft Depth to Water !72 it - Depth of Casing n bgs - RTMENT <br /> DcSmUi CT10N SPICINICATzoy <br /> Sealing Malarial from __0 It bgs to DO R bgs Filter Material-42.�Q" from !'P45s' ftbgs tD R bgs <br /> Well casing to be perforated by one of the following methods: I from ft bgs to ftbgs <br /> ❑ AMIIs Knife Number of cuts everyft and for <br /> Explosives}? Detonating cord ❑ will)projectiles every R ❑ wilhout projectile <br /> C3Detonating cord and boasters ❑ with prciecliiles everyft ❑ Wilhout projectile <br /> ❑ Other <br /> Sealing Material Neat Cement(94 lb bag/5-6 gal wafer) Sand Cement AX 3-sack mix/7 gat water Bentonite Pellets <br /> Bentonite(20%solidsi Manufacturer Spec%solids_% Name Specs on File SpecsSubrrtted <br /> Placement Method r/Pumped Free Fall Other <br /> Seal Completion Complete with Mushroom Cap 3 fl bgs Compete to Existing Surface Pad <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WrTH SAN <br /> JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL ' <br /> WORKERS COMPENSATION LAWS. <br /> - - - - - <br /> cotiTRACTDRssI1: R .. _. �...�TC porate Sec& tory 3/6/20 <br /> yr , <br /> DEPARTt ENT USE ONLY a <br /> Application Accepted Byo <br /> Date L' Z La Area <br /> -'A DesutltlionlnspectionBy � ft-Kg a p�" Date at/ Employee IDS <br /> �/Qy COMMENTS � r <br /> Pr PE SC Received Chock#J Amount Date <br /> Codes Pem,lU Invoice S AYell IDS <br /> Info Cash Remitted a Ic R nest <br /> 3.;t G o <br /> ■ <br /> END,3.D8 `f8�5� ■� <br /> WELL DESTRUCTION PERMIT <br /> 1 O/507 <br /> M <br /> L-d tiL9EL8860Z out SAGIIiaa 80UP-MJnd d8Z:£0 OZ 90 J <br />