Laserfiche WebLink
WELL DESTRUCTION PERMIT <br /> PUBLIC WATER SYSTEM ❑Yes N No <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205 -(209)468-3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS 1000 Goodwin Dr. CITY/ZIP Ripon 95366 <br /> CROSS STREET S. of W. Colony Rd. APN 261-020-38 PARCEL SIZE I.79LAND USE APPLICATION# c <br /> — c <br /> OWNER DASCO Greenwood, LLC c/o Modesto Sand & Gravel PHONE 209-545-4425 Tracy v <br /> 'l. <br /> OWNER ADDRESS 6137 Hammett Ct. CITYISTATE/ZIP Modesto. CA 95358 <br /> CONTRACTOR Hennings Bros. Drilling Co., Inc. PHONE 209-545-1185 <br /> CONTRACTOR ADDRESS 1930 Ladd Rd. CITYISTATEIZIP Modesto, CA 95356 <br /> �fi C-57 WELL DRILLING LICENSE NUMBER 290813 EXPIRATION DATE 5-31-24 <br /> PERFORATION CONTRACTOR _ .PHONE <br /> PERFORATION CONTRACTOR ADDRESS CITYISTATE/ZIP <br /> 6 C-57 Well Drilling License Number 290813 Expiration Date 5-31-24 <br /> ❑ Bureau of Alcohol,Tobacco and Firearms-Users of High Explosives License Number Expiration Dale <br /> ❑ CHP Hazardous Material Transportation for Explosives License Number Expiration Date <br /> ❑ San Joaquin County Sheriff-Coroner Explosives Application and Permit License Number Expiration Date <br /> ❑ California Occupational Safely Health-Blaster License Number Expiration Date <br /> REASON FOR DESTRUCTION ❑ Dry ❑ Replacement Well ❑ Caved In ❑ Pit Well 11 Inactive ❑ Test Hol <br /> Detected/Suspected Well Water Contarninant(s) �� /�� <br /> Adjacent propertywith contamination(Address) ��^r- ��91� <br /> Known SoilfWater contaminants at adjacent property �/, <br /> ExISTING WELL.CONSTRUCTION DETAILS ❑ Open Bottom ❑ Gravel Pack ❑ Uncased ❑ Other v <br /> Well Log copy attached ❑ Yes ❑ No Grout Seal ❑ No ❑ Yes fl below ground surface(bgs) Hole Diameter SA^^-- <br /> Well Conductor Casing ❑ Yes ❑ No Depth of Conductor Casing It bgs Diameter of Conductor Casing C UN <br /> Well Casing Diameter 4" steel inches Total Depth est. 10 ft Depth to Water ft Depth of Casing `LrH IN TAk y <br /> DESTRUCTION SPECIFICATION <br /> Scaling Material from__0___ft bgs to est. 100 it bgs Filler Material from ft bgs to fl bgs <br /> Well casing to be perforated by one of the following methods: from it bgs to ft bgs <br /> ❑ Mills Knife -Number of cuts every ft and/or---__----__ <br /> ❑ Explosives ❑ Detonating cord ❑ with projectiles every ft ❑ without projectile <br /> ❑ Detonating cord and boosters ❑ with projectiles everyit ❑ without projectile <br /> ❑ Other _ <br /> Sealing Material Neat Cement(94 Ib bag/5-6 gal wafer) Sand Cement sack mix/7 gal water Bentonite <br /> Pellets <br /> Bentonite(20%solids) Manufacturer Spec%solids % Name Bariod-Quik Grout Specs on File Specs Submitted <br /> Placement Method Pumped Free Fall Other <br /> Seat Completion X Complete with Mushroom Cap 5 ft bgs Complete to Existing Surface Pad <br /> MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS, CALL(209)953-7697 FOR INSPECTIONS <br /> EP R T M ENT US E O N L <br /> WA <br /> Application Accepted By / Date �L Area 7 <br /> Destruction Inspection Byj < C 'u -� Date L L t_ Employee ID'# 4. <br /> COMMENTS l( 4- 6;A <br /> V �ti2 h C G. <br /> PE SC ReceivedCheck# Amount Permit]Codes Info B emitted Date Service Request# Invoice# Well ID# <br /> I <br /> I <br /> EHD 43-08 WELL DESTRUCTION PERMIT <br /> 11123121 <br />