WP0045477 - Laserfiche WebLink

Home Browse Search

WELL DESTRUCTION PERMIT EMAILE®u _ PUBLIC WATERSYSTEMF�Y Lam}No C-1 1 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205 - (209)468-3420 NON-REFUN BLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 'I YEAR FROM DATE ISSUED n JOB ADDRESS 110ea0 West Grant Line Road CITY/ZIP Tracy,95391 v CROSS STREET Malbeny Lane APN 209-07-023 PARCEL SIZE 3'vas LAND USE APPLICATION It o OWNER Tri Pointe Homes PHONE(925)804-2266 N OWNER ADDRESS 2700 Camino Ramon, Suite 130 CITYISTATEIZIP San Ramon, CA, 94583 CONTRACTOR Pitcher Services,LLC PHONE(650)328-8910 CONTRACTOR ADDRE5S 218 Demeter Street CITYISTATEIZIP East Palo Alto,CA,94303 Q C-57 WELL DRILLING LICENSE NUMBER 1044895 EXPIRATION DATE 09/30/2024 PERFORATION CONTRACTOR PHONE PERFORATION CONTRACTOR ADDRESS CITYISTATEIZIP ❑ C-57 Well Drilling License Number Expiration Date ❑ 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 Np Inactive ❑ Test Hole Detected/Suspected Well Water Contaminant(s) Adjacent property with contamination(Address) Known Soil/Water contaminants at adjacent property Exts'ri WELL CONSTRUCTION DETAILS ❑ Open Bottom ❑ Gravel Pack ❑ Uncased IN Other Unknown Well Log copy attached ❑ Yes 6 No Grout Seal ❑ No ❑ Yes ft below ground surface(bgs) Hole Diameter 6 inches Well Conductor Casing❑ Yes IN No Depth of Conductor Casing_ ft bgs Diameter of Conductor Casing inches Well Casing Diameter 6 inches Total Depth Unknown ft Depth to Water Unknown ft Depth of Casing Unknown ft bgs DESTRUCTION SPECIFICATION j}_t,y,I, ir4� Sealing Material from 'I'll ft bgs to °'°p°`0 ft bgs Filler Material from it 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 11Explosives 13Detonating cord ❑ with projectiles everyIt ❑ without projectile O Detonating cord and boosters ❑ with projectiles every ft ❑ without projectile ❑ Other weii ms-ig dac^eter c S,no per.'orayons neeCeA to plant im. PeIISe�aling Material 0 Neat Cement(94 lb bag/5-6 gal water)❑ Sand Cement sack mix%1 gal water C Bentonite ❑ Bentonite(20"/6 solids) ❑ Manufacturer Spec%solids % Name ❑ Specs on File C Specs Submitted Placement Method a Pumped C Free Fall El Other Tremie Pipe grout to surface ager establishing bottom of well Seal Completion C Complete with Mushroom Cap ft bgs 0 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 �^ Date Area G — Destruction Inspection By �,,D{ate 15 Employee ID# COMMENTS �+�° w 17 Ctl�t �ZCI cl tyec— `� (amu GI"� ��(�l� LLD i S`A(/ail C l AFD 20N PE SC Received Check#/ Amount tDate PermiU Invoice# Eq�Th �9 LZ fV CO Codes Info B \, Cash Remitted Service Request# lyTy ~Nrf` Nr EHD 43-08 r WELL DESTRUCTION PERMIT 11!23121 V