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~ HEDMAN WELL SERVICES, INC. <br /> PO BOX 293655 <br /> SACRAMENTO, CA 95829 <br /> 916-383-3636 <br /> 7 yr Gvl�ti� L��IVELL DESTRUCTION SUPPLEMENT PERMIT# <br /> Note: A copy of the original "Well Completion Report" (DWR Form 188)or equivalent shall be submitted for each well <br /> under consideration for a destruction permit. <br /> TYPE OF WELL: <br /> K Domestic/private i Dewatering i Monitoring/extraction <br /> I Cathodic protection 1 Irrigation/agricultural i Other: <br /> EXISTING WELL CONSTRUCTION DETAILS: <br /> X Open bottom :1 Filter Pack C Uncased F- Other: <br /> tb Pump type: 4UD :1 Oil: Nb L Obstructions: /Vc-21� <br /> L Casing depth: X--Casing diameter: L Method used to ID casing depth: <br /> pf Total depth: 7 Z Water level: LD L Conductor casing: <br /> PROPOSED DESTRUCTION SPECIFICATIONS: <br /> k Pressure grout from:AL2-feet below ground surface(BGS)to:_ feet bgs. <br /> k Over-drill all casing and well materials from: ft.BGS to existing grade. <br /> V, Casing perforation from: ft. BGS,to: ft. BGS, by one of the following methods: <br /> :1 Mills knife: �] #of cuts: per each: ft. <br /> -4r,o Explosives: i Detonation cord: Placement from: ft. BGS,to: feet BGS. <br /> -1 Boosters: Placement every: feet,from: ft. BGS,to: ft. BGS. <br /> Other: <br /> Sealing Material: -1 Neat cement(5-6 gal H2O per 94 lb.cement) X sand-cement slurry(10.3 sack mix) <br /> -1 Cement with up to 5% bentonite(w/w) P Concrete <br /> :1 Bentonite: _ Chips/Pellets Product: <br /> Slurry Product: <br /> Estimated void volume(well casing, borehole,and filter pack voids): 3 • `l 7 <br /> Comments: <br />