Laserfiche WebLink
WELL DESTRUCTION PERMIT <br /> PLIMCWA'IERSYSTI'M ©Nes 1"N. <br /> SAN JOAQUINCUUNI}I"%IROSMI NI�L IILAL111 DLI AIIIAtLNI 3041 Wl Lit le A%13' II SIULONC1J5202 (207)4683420 Y <br /> NON-Rrr-UND413LC FCRN111 CALL(2119)993-7697 1 OR INSPI( l IONS L\111RES7YEAR FBONI DATE ISSUED <br /> 4uultLss �63`j N Wr L3cr�l Wfi�j }� CII !/tt SToCK7`�'J <br /> 111S11lLLI b-d- OgLZ A-Vff APN «-7—C'-7 ' PAM-1,LS17L L%\n l�Sh r\I t'LIC111UN# <br /> ()\vNl R—._!_21�._`/&b' ,6 �_ 4- "'0' (ZO�0-(6 s <br /> Owm It AUURI SS { �_ CIIVISIAILJZII_ <br /> CONIIIACIOR liyocl,clK Wr--t'L -f-'C IVO L-CJ6r1 /NC- /I p.5 -- <br /> CONO <br /> TRAC R ADDRESS 7•Q Fox J t CITY/SIATEIZ[P FA)?- OA93 CA ( 6 <br /> 9NT9 <br /> —C57\4'ELL DRILLING LICENSE NUM(Wrt73( 133 rXPIRAIIOND%TEK 1�0 10. <br /> PERTORAIION CON VRACTOB?c-1A/P'-c?, WE'[-t4 iE ?*vGaoCy!_ CNC PItONE)( <br /> 1 �c <br /> PERFOI7AT[OY CONTRACTOR gppRF.SS% ��r�� CLTY157ATFJZ[Px �1 <br /> C 57\4e11 Dnl[lnj, License Nuurbcr -7 r I `' Explraho ate ! 3! 07 <br /> W. Bureau of Alcohol Tobacco and Flreamis-Users of l[Igh Explosives Llcense Number�CA0(--7�4AL0713LS."r I: Date / l 0 b <br /> CI3PHazardousMateaalTmnsportahonfor$xploslves�ls�b�/1 Llcense Number ta"I1 (� ExpRaponDate ? 3f <br /> S sn Josqurn County Shentf Coroner Explosives Application and Permit License Number O 4 !a Expiration Date <br /> Cal donut Occupatlonil Safety li calth Blaster License Number IN`16 Cxpnrttnon Date fz 2r 0`T <br /> RL ASON I UR.DLS'I KUM lUN ❑ Dry ❑ Replac,.meut Well ❑ Caved In ❑ Pit Well hmactrve ❑ Test l Tule <br /> Detected ISuspected Well Water Contaruutaitt(s)'jZ^E)" so-5 —3 o b <br /> Adjacent propertywlds contanunatiuu (Address)��7� Nr u""\,Soil-VAY pX70( /V t/Y 1 L_SozV \."Y <br /> KnOW1l Sod/Water cantanussunts at adjacent property_-r-R4 Z'f 9-1 2FX , /Iii7Z., It Z- <br /> 1'x11I ING WI I I ON41 RUCI ION lll TAII 0 Op,li Builuns ❑ Gravel Puck ❑ UllLascd X Otiter U/O1QV0 W/L" - <br /> WLII Lug copy ntt mhed C7 Yes Nu Grout Scsl ❑ No ❑ Yes ft below 6ruund surface(b6s) Dale Diameter taches <br /> Wu[I Cmtdu clot Cas,ub ❑ Ycs Q No llcpih of Cund clor Casmb St b6srr� llnusncicr or Conductor Cosurg us,.hcs <br /> f 5o ft Dc dh to Walcr " bO R Depill of Casm"F fS0 fib s <br /> Weil C sshng DL uucter mm�--Inches Total Dcptb I p 6 6 <br /> D LSI RUCTION St ECI rIC 1I ioN <br /> Sealing Nfaten nal from Z) ft b6s to 5Q Et bgs Filler Material from ft b6s to R b6s <br /> W01 Lusutg to bL ucrfol lied by opc of the following methods ft om ft bbs to_fi'D (I b6s <br /> ❑ Aldls Knde Number of cols every R and I or <br /> `�Cxploslvcs IDDetonatmj cord ❑ wall projectiles every R ❑ without projectile <br /> Delonatutb cord and boosters L191' with projectiles every--r,�ti f�wnhout projectile <br /> Ic❑ <br /> OtheAnil,Males nut ❑ NLAtCUIIC[11(94fLLvb/56j,,rltruru) Srnld CLlllent /O runx l'%6 d wd lu 13Dcutumte I ctlets <br /> ❑ Dentonntc(20%solids) ❑ Manufacturer Spec%solids % Name C7 Sp'cs on rile ❑ Specs Submitted <br /> tcxsucntMLILc Pumped ❑ ricerill ❑ Otheral ComplLiluu -icCumplLLL wnt[i Musltruuul C Ip 3 I)b6s ❑ Cutuplctc to Lxtststs(,Surfuke P td <br /> I HEREBY CERTin THAT 1 HAVE PREPARED TII1S APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE Rlril SAN <br /> JOAQUIN COUNTI ORDINANCES STATE LAWS, AND RULES AND REGULATIONS I ALSO CERTIF1 THAT AIY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE:WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE 14ITH ALL <br /> WORKERS COMPENSATION LAWS <br /> MINIMUM 24 110P7 AU rk 01EICrnERL1QUIRLD 11OR 1NSPLC l IONS 11r7DATE � <br /> CONTRACTORS 5[GNATG RE // <br /> r <br /> Ica <br /> 0 <br /> t , <br /> DEPARTNIENr USE ONLY <br /> Application AcceptLd6 Date A,,i <br /> Desrructsun Inspcctwrt BY D dL Culplu)cc 0II <br /> •NIChTE � /�-� "�o <br /> RokmLd [.hold!! tunomn( )ate I'usill/ luwl�r# 15,11 ID# <br /> Cod" lulu I DI L MN Rmimenl SLT,Ice lice uest 0 <br />