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MDR4R4651 - SOP <br /> P.07 <br /> AUG ?, 3 2006 WELL DESTRUCTION PERMIT <br /> r <br /> rt <br /> ENVIRONMENT HEqti-i�lirINCotth-rvF.t,ViRtVNMEN'IAI.IlICA1111 I)i,rkmrmv:N*i 304EWERERAVE Y"Vi.-SI(H-K I 4)1o('A 9$201-(SM)469.3d20 <br /> PERMIT/SERVIRrIFUNDABLE1 IT 'q EXPIRES I YEAR FRIIN,DA'ry TWIED <br /> -106 A Flo" <br /> APN —PARCEL STZE. LAND INE AN-LitWININ9 <br /> QWNFR Ahm WlKfe- Usfn <br /> OwNER Anus, ad b A! <br /> 2-�CONTRAvrox hf, ()0 t)ST�U ✓ 10 <br /> U C-517 WELL DRILLING LICENSE N.M.E. E <br /> EXPIRATION t 1,9 <br /> 3� Ufn <br /> PERFOk^Tld,'%CUNIAM711311 1 0201 7- If - 1/2/:0-1 <br /> 13 <br /> PERroRATioN CONTRACTORADD;��M mIf/[/4e,) ­(.WY/STATEfZFP'5*bCP—*n0 4 <br /> V1 z('-ST%Vtll Otillinj-4 Narntmi 62 Expirabon Data <br /> 11 Buicau QI'Alvohol.Tubacco and rirearrns-Users affligh r,.xploA;ve% L,wnxNumbv Fi(pinumn Mn, <br /> Licen."Number ',twalion Date <br /> 13 Sn"knNurn Unnity 61wri11-(Vonei Explosives Application and Permit Lit..)Ak,Nk tv. <br /> Expinlion Dart <br /> E3 California 0capaliontil 1,Afaiy Licence Number <br /> ry ❑ Replacement Well ❑ C:avcd 111 0 71 Well it-0,it 0 Test I We <br /> Detected/SutpeciedWell Writer riotAludIA.111(4) <br /> ronramilialium(Address) <br /> Known Soil/Wa(er cuntantillants at adjacent property <br /> I)FIAIIA D (h%71 Bottom U GrayLl Pack 0 (Ineaw"i 0 (llllvf <br /> Well Log copy attached 0 No Croul Seat 0 M. n yk:, It Wow ground surface(bgs) lime ni.—IT, Inches <br /> Well Cood.tlar 4".Ah., 13 P%,- Devibvi'CuoduclurCiasing ft bgs th--ler ar('oA.duct or Ceising. incbec <br /> Well Casing Dinmeler inches Total Depth_ft Depth to WAI— Il Depth of Casing q bo <br /> Sealing M.1—W 1 11 I)gs to It blas rifler Ninterial­­ 11 bits to ft has <br /> Well casing to heptrfgk r�i by one of the ft bgs to__ft lig. <br /> 0 Millitknife W, <br /> n vtotwiv" C1 Ottonatinitcurd ❑ wthpimj"vile;a,,,.,y It El withouirmijeclile <br /> 13 E3 --th t-vikvvIcs vwry ft <br /> E3 Oilitey <br /> S#Ai6k2 MAttr.*1 13 N—i t'rn.eaj(94Ih1.,X t-6mdsalvrJ 13 Sand(.'emear__ uj,,-A wi,;7I-.at ural,, 13 Bentonite Poilots <br /> ❑ Brotaiii(e(20%solids) 13 Manufacturer Spec 5;%nli* 1.. N Specs nn file 0 sp.11 <br /> Pikeentftt Method 13 P 111WA E3 F.-hill 0 Other <br /> Nrwl 0­jAeli.,4 11 Complete Ailh.Mushromm Cap A he;; n L'onivicle to Lmirtiox Surface Pad <br /> I uERray rFRTIPY THAI I HAVE PREPARMA)'PHIS APPLICATION AND THAT THE WORK will.xv 1119)NE,IN ACCORDANCE.WlTN SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES ANI)XFt;l:l.Al'ION& Y I ALSO CERTIFY TIIAT MHkOulKii:1) l.l(vNSI; <br /> CURRENT T AND ACTIVE WITH THE CALIFORNIA CONTRAt-FORS STATE LICENSE BOARD AN'D TIIA I I AM IN COMPIJANCI,WITIIALILS <br /> WORKERS COMPENSA FION 1.AwS. I <br /> A <br /> .11 A N C 1.NI PI I( F 14 EQI'1114.1)FO N <br /> CONTRACTORS SIGNATURE-- PAU <br /> V <br /> pA'f INA ENT <br /> RECEIVED,. <br /> AUG 2 9 :2006 <br /> SAN JOP,QUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br /> 1)P.P A H I F-I F,N T 1:5E UNky f <br /> Area <br /> Destruciianlrispectiorilly Date 1011 73 <br /> D. <br /> PF SC Received Amount D.At'a PvrmW <br /> .Codes Info Well Ill. <br /> !ffl7& Service Reattesi ft <br /> 7 j <br /> 14 <br />