WP0044440 - Laserfiche WebLink

Home Browse Search

t � ' WELL DESTRUCTION PERMIT EMAILED a�a3 ss PUBLIC WATER SYS ❑Yes [j 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 250 Maple Ave. cmy/zIP Ripon, CA 95366 m CROSS STREET N. of West Main St. APN 259-03-005 PARCEL SIZE .27 LAND USE APPLICATION# o OWNER Maria Olivia PHONE 209-409-9649 m v OWNER ADDRESS 250 Maple Ave. CITY/STATE/ZIP Ripon, CA 95366 CONTRACTOR Hennings Bros. Drilling Co., Inc. PHONE 209-545-1185 CONTRACTOR ADDRESS 1930 Ladd Rd. CirY/STATE/ZIP Modesto, CA 95356 ❑ C-57 WELL DRILLING LICENSE NUMBER 290813 EXPIRATION DATE May, 31, 2024 PERFORATION CONTRACTOR PHONE PERFORATION CONTRACTOR ADDRESS CITY/STATE/ZIP 17 C-57 Well Drilling License Number 290813 Expiration Date 5-31-24 ❑ 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 G Inactive ❑ e I E� Detected/Suspected Well Water Contaminant(s) Adjacent property with contamination(Address) Known Soil/Water contaminants at adjacent property U 4EL44 EXISTING WELL CONSTRUCTION DETAILS ❑ Open Bottom ❑ Gravel Pack ❑ Uncased ❑ Other SAN JO Well Log copy attached ❑ Yes 6 No Grout Seal ❑ No ❑ Yes ft below ground surface(bgs) Hole Diar IR0NM N Y Well Conductor Casing ❑ Yes ❑ No Depth of Conductor Casing ft bgs Diameter of Conductor Casing �tPA R&hWN Well Casing Diameter 6" Steel inches Total Depth est. 50' ft Depth to Water ft Depth of Casing ft bgs DESTRUCTION SPECIFICATION Sealing Material from 0 ft bgs to 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 every__ft ❑ without projectile ❑ Other Sealing Material Neat Cement(94/b bag/5-6 gal water) Sand Cement sack mix/7 gal water Bentonite Pellets Bentonite(20%solids) a Manufacturer Spec%solids % Name Bariod Specs on File Specs Submitted Placement Method Pumped [X Free Fall Other Seal Completion Complete with Mushroom Cap ft bgs X Complete to Existing Surface Pad cement Cap to floor MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS, CALL(209)953-7697 FOR INSPECTIONS DEPARTMENT USE ONLY Application Accepted By L Date �} �� Area LAA Destruction Inspection By - Datej 0� 23 Employee ID# t'�L / COMMENTS l `t::�'f(".tf'!�t '�°'T�I-1ft�G't'r �tlrt tc� (tll i�t,�.L { y �yGl4 tX��,.t 4K PE SC Received Chec Amount Date Permit/ Invoice# Well ID# Codes Info B Remitted Service Request# EHD 43-08 WELL DESTRUCTION PERMIT 11/23/21