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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue - STOCKTON CA 95205 - (209) 468-3420 <br />EHD 43-08 <br />11/23/21 73333G <br />WELL DESTRUCTION PERMIT <br />WELL DESTRUCTION PERMIT <br />PUBUC WATER SYSTEM ID Yes D No <br />MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS, CALL (209) 953-7697 FOR INSPECTIONS <br />DEPARTMENT USE ONLY <br />Application Accepted By .il 2._, 1,-- Date ///e/;2,7 Area <br />Destruction Inspection By Date 'Ill 1 22--- Employee ID# Ms <br />COMME TS adhod it WO , ' wPooqacioa ft, by pic,Led 1..zo,nc sp-61'. <br />tb -be, t3Veilairi le d <br />PE <br />Codes <br />SC <br />Info <br />Received Check#/ <br />Cash <br />Amount <br />Remitted Date Permit/ <br />Service Request # Invoice # Well ID# <br />1-134 •,%' Olkw O <br />43 2. <br />V;$ a-- :t I s-a. 1.1%42 we 0 D(4,2,01 0 g :SS321OCIV 311S EXPIRES 1 YEAR FROM DATE ISSUED NON-REFUNDABLE PERMIT CALL (209) 953-7697 FOR INSPECTIONS <br />CONTRACTOR Gregory Drilling, Inc PHONE 530-565-6289 <br />LICENSE NUMBER 1007649 <br />NA <br />CONTRACTOR ADDRESS 14112 452nd ave Se <br />[X C-57 WELL DRILLING <br />PERFORATION CONTRACTOR <br />PERFORATION CONTRACTOR ADDRESS <br />CITY/STATE/ZIP North Bend, WA 98045 <br />EXPIRATION DATE 1-31-23 <br />PHONE <br />CITY/STATE/ZIP <br />% Name <br />JOB ADDRESS 0. El Dorado St and E Anderson <br />CROSS STREET E Anderson APN 1. <br />OWNER PG&E <br />OWNER ADDRESS 3965 Occidental RD <br />CITY/Zip Stockton, Ca 95203 <br />PARCEL SIZE LAND USE APPLICATION # <br />PHONE <br />CITY/STATE/ZIP <br />C-57 Well Drilling <br />Bureau of Alcohol, Tobacco and Firearms - Users of High Explosives <br />CHP Hazardous Material Transportation for Explosives <br />San Joaquin County Sheriff-Coroner Explosives Application and Permit <br />California Occupational Safety Health - Blaster <br />License Number Expiration Date <br />License Number Expiration Date <br />License Number Expiration Date <br />License Number Expiration Date <br />License Number Expiration IPA <br />EXISTING WELL CONSTRUCTION DETAILS 0 Open Bottom 0 Gravel Pack o Uncased 0 _ d opftENV/F2 iN C <br />Well Log copy attached 0 Yes til No Grout Seal 0 No 0 Yes ft below ground surface (bgs) Hole Diametra0E" -/.4?-011( <br />Well Conductor Casing 0 Yes 0 No Depth of Conductor Casing ft bgs Diameter of Conductor Casing tiVips <br />Well Casing Diameter 2 inches Total Depth 75 ft Depth to Water ft Depth of Casing ft bgs <br />DESTRUCTION SPECIFICATION <br />Sealing Material from ft bgs to ft bgs Filler Material from ft bgs to ft bgs <br />Well casing to be perforated by one of the following methods: from ft bgs to ft bgs <br />Mills Knife Number of cuts every ft and/or <br />Explosives 0 Detonating cord 0 with projectiles every ft 0 without projectile <br />0 Detonating cord and boosters 0 with projectiles every ft 0 without projectile <br />IX Other Existing Cathodic well will be overdrilled and removed. New well to be installed in same Hole WP00042902 at 200' <br />REASON FOR DESTRUCTION 0 Dry DK Replacement Well 0 Caved In 0 Pit Well (3:1 Inactive <br />Detected/Suspected Well Water Contaminant(s) <br />Adjacent property with contamination (Address) <br /> 2072— Known Soil/Water contaminants at adjacent property <br />Pellets <br />Sealing Material X Neat Cement (94 lb bag/5-6 gal water) Sand Cement <br />Bentonite (20% solids) Manufacturer Spec % solids <br />sack mix/7 gal water Bentonite <br />Specs on File Specs Submitted <br />Placement Method Pumped Free Fall Other <br />Seal Completion Complete with Mushroom Cap ft bgs Complete to Existing Surface Pad <br />719 0 <br />Santa Rosa, CA 95401