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0 <br />0 <br />0 <br />0 <br />0 <br />C-57 Well Dnlling <br />Bureau of Alcohol Tobacco and Frearms - Users of High Explosives <br />CHP Hazardous Material Transportation for Explosives <br />License Number <br />License Number <br />License Number <br />License Number <br />License Number <br />San Joaquin County Sheriff-Coroner Explosives Application and Permit <br />California Occupational Safety Health - Blaster <br />REASON FOR DESTRUCTION Dry CI Replacement Well <br /> <br />0 Caved In ID Pit Well <br />Expiration Date <br />Expiration Date <br />Expiration Date <br />Expiration Date <br />Expiration Date <br />IX Inactive P Test Hole <br />DEPARTMENT USE ONLY i <br />Date Cljaq "2 a <br />Date (0 -- Li-- 7022- Application Accepted By <br />Destruction Inspection By <br />COMMENTS <br />A <br />Area <br />Employee IDS As <br />WELL DESTRUCTION PERMIT <br />PUBUC WATER SYSTEM Yes C;KNo <br />SAN JoAouiN 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 />crrrizip Tracy, (15177 <br />PARCEL SIZE 3 41SE APPLICATION #7 <br />PHONE (510)516-5522 <br />aryisTATEizip Frpmnnt, CA q4518 <br />PHONE (209)667-7932 <br />CITY/STATE/ZIP Turlock, CA 95380 <br />5/31/23 <br />Cm/STATE/2w <br />Detected:Suspected Well Water Contaminant(s) <br />Adjacent property with contamination (Address; <br />Known SoilMater contaminants at adjacent property <br />0 Open Bottom 0 Gravel Pack 0 Urcaset 0 Otner <br />Grout Seal 0 No 0 Yes ft below ground surface (cgs l Hole Diameter <br />Depth of Conductor Casing It bgs Diameter of Conductor Casing <br />Total Depth Depth to Water Depth of Casing <br />DESTRUCTION SPECIFICATION <br />Sealing Material from 80 ft bps to 0 ft nas Filler Material <br />Well casing to be perforated by one of the following methods: from <br />Mills Knife Number of cuts every ft andlor <br />Explosives 0 Detonating cord 0 with projectiles every <br /> <br />0 Detonating cord and boosters 0 with projectiles every <br />Other <br />Sealing Material Neat Cement (94 lb bag/5-6 gal water) Sand Cement sack mix.17 gal water Bentonite <br />Pellets <br /> <br />X Bentonite (20% solids) Manufacturer Spec % solids 2.0 % Name <br />Placement Method X Pumped Free Fall Other <br />Seal Completion 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 />JOB ADDRESS 24322 S. Hansen Rd <br />CROSS STREET Promontory Pkwy APN 209-400-090 <br />OWNER Tom Martin for Prologis LP. <br />OWNER ADDRESS 3353 Gateway <br />CONTRACTOR Calwater Drilling Co <br />CONTRACTOR ADDRESS 300 S. Kilroy Rd <br />R C-57 WELL DRILLING <br />PERFORATION CONTRACTOR <br />PERFORATION CONTRACTOR ADDRESS <br />LICENSE NUMBER434218 EXPIRATION DATE <br />PHONE <br />EXISTING WELL CONSTRUCTION DETAILS <br />Well Log copy attached 0 Yes 0 No <br />Well Conductor Casing 0 Yes 0 No <br />Well Casing Diameter 1 inches <br />PAYIVILNT <br />ft bgnCEIVEDft bgs <br />Indies <br />inches <br />ft bgs <br /> <br />ft bgs to <br />MAI ü non <br /> <br />ft <br />ft <br />0 without projectile AN JOAQUIN COUNiY, <br />13 without projectile ENviRoNmENTAt. <br />HEALTH DEPARTMEIAL <br />Wyoben x Specs on File Specs Submitted <br />PE <br />Codes <br />SC <br />Info <br />Received <br />AY <br />CheckS/ <br />Cast) _ I <br />Amount <br />Remitted Date Permit/ <br />Service Reauest ft Invoice 0 Weil IDS <br />J373 )(-.. i . \11c-D A-- *icis— 1.714.2- OPOOLI3155 <br />_........_....—, ..2 4 i <br />WELL DESTRUCTION PERMIT <br />END 43-08 <br />11/23/21