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WELL DE–'_KUGTIUN IJLKMI 1 — PUBLIC WATER SYSTEM G—t ❑No SAN JOAotm Courrr ErrwwoeveNTAL HEALTH D"ARniwr 600 E MAN STRdfT-STOCKTON CA 95202-(209)465.3420 NON-REFummAu■PmAff CALL 953-7097 FOR Mpacnoks EXPIRES 1 YEAR FROM DATE ISSUED m .ION ADOOM 17 ,946 N. w Crtr12]P -p CJS > M �� '> f 1 Caoas STerar Y ♦ L APN - V-S 1 PARCEL ND S¢E_LAUse APPLICATION 9 °0 17 � oweree l+rlo ke l n+✓►t %,)f r Sc_I^oo 1 Co r Ap P.. ONNIR ADOPMS O Be -3 q9 CrrYMTATFlZ/ L-O S Y O ( C' i ryr� n 2l �y IIJJ L CONTRACTOR D � .-� PHowd Baa (01" 6 0 O CON RACTON ADOOK" D CRYIBTATErzr LD �' M p `� Cd/W1sL Dataj.04 LICENSE HUBOMR D O ElareAnoH DATE 413-01 >010 M]�^ 0 PENTION CONTRACTOR PHONE (.0IDRA PPwolt,a w COMiRACTost ADomm CIrY/STATTJZR_ v ❑ C-57 Well DAdYIg License Number Expiration Data ❑ Bureau of Alcohol,Tobacco and Fraarma-Users of High Explosives License Number Expiration Date ❑ CHP Har rdous WANII Transportation for Explosives License Number Expiration Data_ ❑ San Joaquin County SherM-honer Explosives Application and Permit License Number Expiration Data ❑ California Occupational SatYty Health-BIMW License Number Expiration Date ❑ Dry ❑ Replacement Well ❑ Caved In ❑ Pb Welt Inadtw ❑ Teat Hole Z•%4LJ-t9^ L. II - Qlu1kA6,. ,am._toar us 604 err+PeiEAer+as� ri u rAe Known SoU Nater conternMugb at adjacent property ..... _ -.- -.--- - Emma VftLL CDNffrm)CTM DETAILS ❑ Open BdEorn ❑ Graval Pads ❑ Uncalled ❑ Otho Well Lag copy attached ❑ Yes ❑ No Grow aw ❑ No Ya.j7__V0 R below ground d surface(bgs) Hae Dlarn er Jj 1- Indww Wad Candwcter Calling❑ Yes ❑ No Depth d CawYrelr C&Sft It bgs Diameter of Conductor Caskw Inches Wed Caeft DlsnwWJ-(>-BL�L wishes Tod Depth 3aw-_+R Depth to Water R Depth of Casing ft bgs Ca t,Ln jt 1"94L 99 artt Specs i Sodirp MdbrW Iran n bgs to n bps FIS&Madatat - __.hom_ It bps to It bgs Wad uMrp to be performitild by one of tho falwbw nwMBOdd:_ - nnrrl____- R bps to It taps ❑ Mills Krill Number of arts every __..R and/or ❑ Expioslwa❑ DNtnnauntg cad ❑ wtdl projectiles every N ❑ without proles iie ❑ Detonatnp caro and boosters ❑ with projectiles every-- n ❑ witnout projectile ❑ oma_-- —..---..____-- Spnnp UNIndel Wpt CerrrNrl igt ib bap"SB gN nater)❑ Sand Conwrd sack mar/7 gaf water Bentonite"lets SwAonib(20%sodda) - tvtanufacarar Spec%solids_% Nene ... .------ r Spam on Flo Spas Submitted Ptacerrwrd McUwd r, Pumped .^_ Free Fall U Other Seal Compilation -_ Complain,with Muahroorn Cap ft bps ;1 Compiet s to Existing Surface Pad I HEREBY CERTWY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN j JOAQM COUNTY ORDO ANCIE, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY RECUitEO LICENSE IS CURRENT AND ACTIVE W"M THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKERS COM MEMSATION LAWS. � U 24 HOU V CE NOTICE REQUIRED FOR INSPECTIONS AIy 's� COMntAcrolta 31oMATIM[ /, Y TITLE_[ (i,. DA7!_��_!L�/q Aldi r ar. DEPARTMENT USE ONLY Ll a U Area Y _ Applicator Accepted YDate ... Date Q_ Employee ID# L LI y _ Destruction - — COMAAENTS r q 2Luo PE Colics Indo Carp Rom lthW Dia Sarvf t d Imola a Won IDB 5 ColL6l �"'L 3 1�__-3�S I .... -1- ---- ---- — END 4148 � ��y,�' WELL DESTRUCTION PERMIT