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Insoles 0 Well V/ <br />.11/ EtANI 0.11 It lit ptnot I5i5 11 RAM <br />WELL DESTRUCTION PERMIT <br />Bentonite Pellets <br />&FMK, SA 0111,11n <br />Out.. <br />Sealing Materiel lead Cement OM /0 Sag / 54 gal avrier) Sand Cement .1.041 sort eat I i gal dem <br />Bentonie• (10% solids) lAanulactuner Spree % solidi % Nemo SpOog on Elle <br />Placement Method ..><Ptimped Tree Fat_ Other <br />Seal Completion Complete NATI Mushroom Cap _ _ hds X 1-.101010e i. E•itinng Strew* rm <br />Pusan. Said LANct Usi Arvur.Anom <br />Moue <br />A/ <br />c Rosa snug; HA oq I q 0 3 6a•-epi,,),QA vie /tiow Pek.44.9/,cw. <br />brivivraig RP <br />Puauc WATER SYS1131 Yee 0 No <br />1141 E sot Haze llon Avenue - STOCKTON CA 552064132 - (100)4411-3020 <br />CONTRACTOR Atm/or:our ke4TE,c WtU <br />fijscv CONTRACTOR ADDRESS Sci,1:-; 6etreilIVAer,66- RI) <br />EURATOM DA111_,VW/C2a-V <br />P14 — at. <br />CrrriZa• <br />951717 <br />SAN J OA a UPI COUNTY Eiiittso till. HEALTH DEPT <br />N N-RE FUNDAaLE PERMIT <br />Joe ADORES. IG 0 I ilk <br />20112.3-1.97 FOR (NSPEC ri EXP -ESIY .1,, DATE ISSUED <br />irgarAIIMMINI <br />r,e/I6v_x_A <br />Pharrq.ac 9A'n /0154 <br />C-57 Writ. DRILLING Licosa Hunan <br />PERFORATION CONTRACTOR/ <br />PERFORATION CONTRACTOR Aotalett <br />)71. C-ST Wel Drilling <br />Bureau ci Mocha& Tobacco end F towns - Users el High E splashes <br />CHP Hazardous Material Transportabon Ici Eqepenee <br />San Joaquin County Sherr-Coroner Explosives Appecelon end Penne <br />Cal/arms Occupational Safety Health • Medd <br />CITA?* rtiziej.: <br />ECroso Hunt. Exposition Dale <br />kertie Number Expeation Da% <br />cense Numb.* veetvn Owe <br />1 slims' Numher Eva aeon Date <br />License Photos Expeehon Date <br />81614liimaniusage D Dry Ci <br /> <br />Detected Suspected Well Water Contaminant(d <br />Advertent peopRrty with coot-mon/Mon I/04NY <br />Known Sod I Water cnotanonants AA 1141AFC•04 010TirTY <br />CINIPd In Wea Ted Hole <br />1../11 Mu CattentucEme DETAIL' <br />Wall Log mos allached 0 Yes _Sr No <br />Well Conductor Casing 0 Yes )11. No <br />Well Casing Diameter <br />(3 Open Nam )4(....Orevel PIKS 0 Orscased 0 Ogler <br />Grout Seal)! No 0 Yoe ft twoe ground acetic* Rol Hole Dien... <br />Depth ni concludes Cooing 11 Na Dienieter SiConsorter Casing A. /1 Impact <br />Total Depth TO It Depth le Wale ati Depth el Castel gc.) Stv. <br />. 0....a <br />Wall Wall casing to be rufgalgsf by pne el the foRcimnostEthEt‘ treat TI bps W I N. <br />Mills Knife thanhce te cies every Ii atilt Of <br />E plOSJ VS*. Oolonating cord 0 *Strjn.tlosac.ry 11 <br /> <br />O'Oolonaling cord Ind boaster* 0 web posh, Moe ryoty /I <br />lassittit 111,1•re 11tLIJj <br />Sealing Material horn it 1,0 to —0110t,/it INpi ROW Malarial CAPtiledrtf, <br />%PIPPO MOW, <br />sAMOUI paled& <br />I HEREBY CERTIFY THAT 1 11AVE PREPARI D 11115 APPLICATION AND MAT IIIL WORK WILL FIE DONt IN ACCORDANCE WITH SAN <br />JOAOU1N COUNTY ORDINANCe S. STATE LAWS, AND RULES AND Rt oulAIIONS I ALSO CUMIN' THAT MY REQUIRED LICENSE 15 <br />CURRENT AND ACTDIf WITH DIE CALIFORNIA CON 1RAC MRS STAFF MENU uoAnn AND THAI I AM IN COMPLIANCE WITH ALL <br />WORKERS COUPE NSA tioN I AWS <br />Appktecliefl ACtdichetl By <br />DEI.A1+ troi NY USN 07Y <br />Dote ci °IWO <br />oimartoon hoppown py <br />CCIANALNill , <br />!WENT <br />EIVED <br />9 2020 <br />N COuNly <br />rI <br />E.,,NTAL <br />TMENT <br />ro.• Si CI <br />Dale I (5-1 0 a) miskyyss <br />Amour. <br />ego 0terni tie ii <br />112q12,4 <br />t <br />LA) / <br /> <br />v)hOt ,91 (uk< <br />see VISAS <br />AN (MICE REQUIRED F OR INSRECTIOe a d <br />ans, aimicr I 11 'LC' ( CoeTTO1C50411 {JONA <br />Si 41 HO <br />PA <br />RE <br />SAN joAQ <br />L137