WP0039725 - Laserfiche WebLink

Home Browse Search

WELL DESTRUCTION PERMIT #17850 PUBLIC WATER SYSTEM❑Yes ®No SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue-STOCKTON CA 95205.6232-(209)468-3420 NON-REFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 180 AirportWay CITY/ZIP Mantes 95117 CROSS STREET West Yosemite Ave APN 20014008 PARCEL SIZE xrcs LAND USE APPLICATION# o OWNER Daniel Busch PHONE 209-823-7466 H OWNER ADDRESS 180 Airport Way CITY/STATE2IP Manteca 95337 CONTRACTOR Cascade Drilling PHONE(916)638-1169 CONTRACTOR ADDRESS 3000 Duluth Street CITY/STATE/ZIP West Sacramento,CA 95691 C-57 WELL DRILLING LICENSE NUMBER 936110 EXPIRATION DATE 09/30/2019 PERFORATION CONTRACTOR McMillan Well Services,LLC PHONE PERFORATION CONTRACTOR ADDRESS 12302 Andes Ave CITY/STATE/LP Bakerfield,CA 93312 0/ C-57 Well Drilling License Number Expiration Dale 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 9201 Expiration Date 4/5/2021 REASON FOR DESTRUCTION ❑ Dry ❑ Replacement Well ❑ Caved In ❑ Pit Well Inactive ❑ Test Hole Detected/Suspected Well Water Contaminant(s) MTBE 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 EX No Grout Seal ❑ No ❑ Yes ft below ground surface(bgs) Hole Diameter inches Well Conductor Casing❑ Yes IX No Depth of Conductor Casing ft bgs Diameter of Conductor Casing inches Well Casing DIameter_V±,kjxJJ11 Aches Total Depth Unkown ft Depth to Water Unknown ft Depth of Casing Unknown ft bgs DESTRUCTION SPECIFICATION Sealing Material frorfrotal Depth ft bgs to 0 ft bgs Filler Material None from ft bgs to ft bgs Well casing to be perforated by one of the following methods: from 0 ft bgs to total depth ft bgs ❑ Mills Knife Number of cuts every ft and/or IX Explosives❑ Detonating cord ❑ with projectiles every ft ❑ without projectile IX Detonating cord and boosters 17 with projectiles every 10 ft ❑ without projectile ❑ Other Sealing Material /Neat Cement(94/b beg/5-6 gal water) Sand Cement sack mix/7 gal water Bentonite Pellets Bentonite(20%solids) Manufacturer Spec%solids_% Name Specs on File Specs Submitted Placement Method IPumped IFree Fall Other Seal Completion Complete with Mushroom Cap ff bgs Completelo Existing Surface Pad I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I 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. MI I M 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS CONTRACTORS SIGNATURE TITLE VP Operations DATE 03/29/2019 1,9�R / NCO MFHT Rry�HT TMENT USE O N L Application Accepted By Date (17 Area Destruction Inspe ion By Date Employee I # COMMENTS ' PE SC Received Check* Amount Date Permit/ Invoice# Well ID# Codes Info Cash Remitted 59Wice Re uest# ILI EHD 43-08 Q�j�Q / WELL DESTRUCTION PERMIT revised 4/14/18