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WELL DESTRUCTION PERMIT PUBLIC WATER SYSTEM ❑Yes Z No SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205 - (209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS h r V _,fo?3.7 _[-.c�� p CITY/ZIP Manteca 95336 CROSS STREET N.W. corner of Lathrop RdAPN 204-100-58 PARCEL SIZE LAND USE APPLICATION# do OWNER Nunes Family Properties, LP PHONE 209-471-4538 Art Nunes OWNER ADDRESS 1463 Moffat Blvd., Ste. 5 CITYISTATE/ZIP Manteca, CA 95336 y CONTRACTOR Hennings Bros. Drilling Co., Inc. PHONE 209-545-1185 CONTRACTOR ADDRESS 1930 Ladd Rd. CITY/STATE/ZIP Modesto, CA 95356 1 I C-57 WELL DRILLING LICENSE NUMBER 290813 EXPIRATION DATE May 31 2022 PERFORATION CONTRACTOR PHONE PERFORATION CONTRACTOR ADDRESS CITYISTATE/ZIP N C-57 Well Drilling License Number 290813 Expiration Date 5-31-22 ❑ Bureau of Alcohol,Tobacco and Firearms-Users of High Explosives License Number Expiration Date ❑ CHP Hazardous Material Transportation for Explosives License Number Expiration Date ❑ San Joaquin County Sheriff-Coroner Explosives Application and Permit License Number Expiration Date ❑ California Occupational Safety Health-Blaster License Number Expiration Date REASON FOR DESTRUCTION ❑ Dry ❑ Replacement Well ❑ Caved In ❑ Pit Well W Inactive ❑ Test Hole Detected/Suspected Well Water Contaminant(s) Adjacent property with contamination(Address) Known Soil/Water contaminants at adjacent property EXISTING WELL CONSTRUCTION DETAILS ❑ Open Bottom ❑ Gravel Pack ❑ Uncased ❑ Other Well Log copy attached ❑ Yes IX No Grout Seal ❑ No ❑ Yes ft below ground surface(bgs) Hole Diameter inches Well Conductor Casing ❑ Yes ❑ No Depth of Conductor Casing ft bgs Diameter of Conductor Casing inches Well Casing Diameter 6" steel inches Total Depth est. 1 50f Depth to Water ft Depth of Casing ft bgs DESTRUCTION SPECIFICATION Sealing Material from 0 ft bgs toest. 150 ft bgs Filler Material from ft bgs to ft bgs Well casing to be perforated by one of the following methods: from ft bgs to ft bgs ❑ Mills Knife Number of cuts every ft and/or ❑ Explosives ❑ Detonating cord ❑ with projectiles everyft ❑ without projectile ❑ Detonating cord and boosters ❑ with projectiles everyft ❑ without projectile ❑ Other Sealing Material Neat Cement(94 Ib bag/5-6 gal water) Sand Cement sack mix17 gal water Bentonite Pellets X Bentonite(20%solids) ❑ Manufacturer Spec%solids % Name Specs on File Specs Submitted Placement Method X Pumped Free Fall Other Seal Completion X Complete with Mushroom Cap 5 ft bgs Complete to Existing Surface Pad MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS, CALL (209)953-7697 FOR INSPECTIONS DEPARTMENT USE ONLY Application Accepted By f� Date Area 3/r��f1�t'41, Destruction Inspection By Date �df--,I L Z Employee ID# AAlrArxrl COMMENTS 0 n %./^- �y Qk --'Ulv — PE SC Received h Amount at Permit/ Invoice# We lb Codes Info B Cash Remitted Service Re uest# JS� ��( EHD 43-08 WELL DESTRUCTION PERMIT 11/23/21