FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

� S 1 1 VO�LL DnEpSTRUCTION PERMIT PUBLIC WATER SYSTEM ❑Yes O(No SAN JOAQUIN COUNTY ENVIRONMENTAL.HF.AUrn DEPARTMENT 304 E WEBER AVE 3"°FLOOR-STOCKTON CA 95202 - (209)468-3420 NON-REFUNDABLE PERMIT CALL(209)953-7697 FOR INSPECTIONS EXPIRES I YEAR FROM DATE ISSUED LA JOB ADDRESS 10500 HARLAN RD. CITY/ZIP FRENCH CAMP OWNER GRANITE CONST. CO. A- 11J1 i`13-7-"7'o-y3 PHONE 982-4750 X = o 0 OWNER ADDRESS P .O. BOX 151 .27..1c.•Ys CITY/STATE/ZIPSTOCKTON , CA 95901 � CONTRACTOR HENNINGS BROS_ nRTI I TNG ACID - , TING PHONE 545- 1185 CONTRACTOR ADDRESS 3525 P E L A N D A L E AVE , CITY/STATE/ZIP m o u sS r n , r.A 9 5 3 51, C? C-57 WELL DRILLING LICENSE NUMBER 790,813 EXPIRATION DATE MAY 31 , 2006 PERFORATION CONTRACTOR Same as above PHONE PERFORATION CONTRACTOR ADDRESS CITY/STATE/ZIP 1(1 C-57 Well Drilling License Number 2, 0 R I q Exrnration Date _ _'i _n-(•j._ K7 Bureau of Alcohol,Tobacco and Firearms-Users of High Explosives License Number - - _ --KNk1f8n Date ❑ CHP Hazardous Material Transportation for Explosives n/a License Number _ Expirati Date )bSan Joaquin County Sheriff-Coroner Explosives Application and Permit License Number: _ /HxpiLat} q Date A-6-n 5 h California Occupational Safety Health-Blaster License Number8 9 1'3 ,8 91 4'�gxpi—m on Date 5-6-09 REASON FOR DESTRUCTION ❑ Dry ❑ Replacement Well ❑ Caved in ❑ Pit Well )tX 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 14 inches Total Depth 1 6 0 ft I Depth to Water ft Depth of Casing ft bgs 1 (-Y DESTRUCTION SPECIFICATION Sealing Material from 0 ft bgs to 1 6 0 ft bgs Filler Material from ft bgs to R bgs Q Well casing to be perforated by one of the following methods from 4 R bgs tobgs t0 be determined d 6 Mills Knife Number of cuts every ft and/or �s�after well 1S t.v,Id ❑ Explosives ❑ Detonating cord: ❑ with projectiles every R ❑ without projectile ❑ Detonating cord and boosters: ❑ with projectiles every ft ❑ without projectile ❑ Other Scaling Material ❑ Neat Cement(94 lb hag/S-h gal water) X1 Sand Cement-1-.0--r3-sack rnir/7 gal water ❑ Bentonite Pellets ❑ Bentonite(20%solids) ❑ Manufacturer Spec%solids % Name ❑ Specs on File ❑ Specs Submitted (� Placement Method X7 Pumped ❑ Free Fall ❑ Other Seal Completion: ❑ Complete with Mushroom Cap R bgs IX Complete to Existing Surface Pad 1 HEREBY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COMPENSATION LAWS. MINIMUM 24 HOUR ADVANCE NOTICE REQUIREp FOR INSPECTIONS CONTRACTORS SIGNATURE: I,),\. �x1 `_i WITLE: SUPERVISOR to Boo Pat-ion cnth 4.v,� tavli , l lei I ' , �� f n r - SAN JOAOUIN CONN f / ENVIRONMENTAL NEpL1H DEPARTMENT 4 j i DEPARTMENT S ONLY ' Application Accepted By �C- D to f Area Destmction Inspection By D to Employee ID# . YS COMMENTS �. < •trS[. i /0 PE SC Received C eck# Amount Dte.aPermit/ Invoice# WeII1D# Codes Info B ash Remitted Service Re uest# :45 f ` � 9 9C r rI Enoai-of-oox