WP0042819 - Laserfiche WebLink

Home Browse Search

WELL DESTRUCTION PERMIT e San Joaquin County Sheriff -Coroner Explosives Application and Permit 21- Califomia Occupational Safety Health - Blaster REASON FOR DESTRUCTION ❑ Dry ❑ Replacement Well Detected/Suspected Well Water Contaminant(s) Adjacent property with contamination (Addy Known Soil/Water contaminants at adjacent EXISTING WELL CONSTRUCTION DETAILS ❑ Open Bottom Well Log copy attached ❑ Yes ❑ No Grout Seal ❑ No License Number ��p7— Expiration Date License Number /Oa Date ❑ Caved In ❑ Pit Well X Inactive ❑ Test Hole ❑ Gravel Pack ❑ Uncased ❑ Other ❑ 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 i 21f inches Total Depth 20,0 ft Depth to Water It Depth of Casing ft bgs DESTRUCTION SPECIFICATION 1�C&$1/11 Sealing Material from D ft bgs to ;gq&v -___-ft bgs Filler Material 11 $4641— 51- from O ft bgs to ;7-f b ft bgs Well casing to be perforated by one of the following methods: from 0 ft bgs to_14-p—ft bgs ❑ Mills Knife Number of cuts every ft and/or Explosives lk Detonating cord I( with projectiles every__,I_p_ft ❑ without projectile ❑ Detonating cord and boosters ❑ with projectiles everyft ❑ without projectile ❑ Other Pellets ling Material ❑ Neat Cement (94 Ib bag/5-6 gal wafer) A Sand Cement sack mix/1 gal water ❑ Bentonite ❑ Bentonite (20% solids) ❑ Manufacturer Spec % solids__, - Placement Method ;( Pumped ❑ Free FAL. 7 Seal Completion 19, Complete with Mushroom Cap S Name ❑ Specs on File D Specs Submitted ❑ Other _ ft bgs ❑ Complete to Existing Surface Pad MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS, CALL (209) 953-7697 FOR INSPECTIONS DEPARTMENT USE ON Application Accepted By l },� Date J Z Area 5 k ice" Destruction Inspection By //S�%�(fij /� t� Date_ (' �r� L1 Employee ID# _ COMMENTS ,moi •�t��'�{t,�f"�-.'FYI PE SC Received Codes Info B PUBLIC WATER SYSTEM ❑ Yes ❑ No SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue-STOCKTON CA 95205 - (209) 4683420 NON-REFUNDABLE PERMIT CALL (217191953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED JOB ADDRESS 130 CrTY/ZIP Dl CROSS STREET 1411-4 Ale, y APN S� �! � UiCELSIZELDLAND USE APPLICATION#.1► OWNER SO to r& L-�-L. PHONE 1. %�o d) ?7 / /- 7f/ 7 7 Q1//IJ�Osf OWNERADDRESS 07o Ll�/LLrtr� W- CrrY/STAATEMP J L&C+SAVrP I 1�+. CONTRACTOR/,,V,-'/,,V,-'_ �j,/ji'"/V`/7/'}- SONS � PHONE ` tOW 5 3% -3 4 CONTRACTOR ADDRESS IfL e-5 �-L 'Z CITY/STATE/ZIP I��1PJ� 9S3?a 5J /gyp 9 C-57 WELL DRILLING LICENSE NUMBER 7 / 0 7 EXPIRATION DATE 71 5//A0 3'�— PERFORATION CONTRACTOR O k • LV61--L- Q 77 '- / PHONE C /4) 63 3/ PERFORATION CONTRACTORADDRESS4SSS AvA3 o2tv i01.110 6r'4 CrrylsTATE/ZIP :54024-wo-r0A E/ C-57 Well Drilling License Number V'AS 7`tg(ration Date 7 S/ Z Y ❑1 Bureau of Alcohol, Tobacco and Firearms -Users of High Explosives License Numbert-44494133.4049. iration Date / ,941 G CHP Hazardous Material Transportation for Explosives License Number 9�Z Expiration Date e San Joaquin County Sheriff -Coroner Explosives Application and Permit 21- Califomia Occupational Safety Health - Blaster REASON FOR DESTRUCTION ❑ Dry ❑ Replacement Well Detected/Suspected Well Water Contaminant(s) Adjacent property with contamination (Addy Known Soil/Water contaminants at adjacent EXISTING WELL CONSTRUCTION DETAILS ❑ Open Bottom Well Log copy attached ❑ Yes ❑ No Grout Seal ❑ No License Number ��p7— Expiration Date License Number /Oa Date ❑ Caved In ❑ Pit Well X Inactive ❑ Test Hole ❑ Gravel Pack ❑ Uncased ❑ Other ❑ 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 i 21f inches Total Depth 20,0 ft Depth to Water It Depth of Casing ft bgs DESTRUCTION SPECIFICATION 1�C&$1/11 Sealing Material from D ft bgs to ;gq&v -___-ft bgs Filler Material 11 $4641— 51- from O ft bgs to ;7-f b ft bgs Well casing to be perforated by one of the following methods: from 0 ft bgs to_14-p—ft bgs ❑ Mills Knife Number of cuts every ft and/or Explosives lk Detonating cord I( with projectiles every__,I_p_ft ❑ without projectile ❑ Detonating cord and boosters ❑ with projectiles everyft ❑ without projectile ❑ Other Pellets ling Material ❑ Neat Cement (94 Ib bag/5-6 gal wafer) A Sand Cement sack mix/1 gal water ❑ Bentonite ❑ Bentonite (20% solids) ❑ Manufacturer Spec % solids__, - Placement Method ;( Pumped ❑ Free FAL. 7 Seal Completion 19, Complete with Mushroom Cap S Name ❑ Specs on File D Specs Submitted ❑ Other _ ft bgs ❑ Complete to Existing Surface Pad MINIMUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS, CALL (209) 953-7697 FOR INSPECTIONS DEPARTMENT USE ON Application Accepted By l },� Date J Z Area 5 k ice" Destruction Inspection By //S�%�(fij /� t� Date_ (' �r� L1 Employee ID# _ COMMENTS ,moi •�t��'�{t,�f"�-.'FYI PE SC Received Codes Info B Ch Cash Amount Remitted Date Permit/ Service Re uest# Invoice f 3d 5 ►� 21 �y 2 ^'T EHD 43-08 WELL DESTRUCTION PERMIT 11/23/21