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Oct-25-99 11 : 38A VIRONEX, INC - 5102660963 P - 02 <br /> Sent By: Geo9yntec-Walnut•Cneelc; 925 043 2365; Oct-25.99 11:25; Page 2/3 <br /> V'. 2 <br /> w ' <br /> WELL PERMIT APPLICATION FORME UNIT rV <br /> SAN JOAQUIN coulmTy PUBLIC HEALTH SERVICES <br /> EI MROIYIWWAL HEALTH DIVISIOM(PHS EHD) <br /> 304 E.Weber, Third Floor,Stockton, C4,85202 <br /> (M)488-3448 <br /> Hoa Dation.s hereoy rneae to Saij Jl "Wim REitllaA�I TEwR 1!&2 nAT6 OSU[o <br /> San_10vw n twnlr Dr rebprnerh T(rte Cb Oar 2-1118,3 and the Slaefderds OrSa►1 andta If+t wpY dascrlbed The aPDacauow�mwoe Irl l)onyfiwnee wYn <br /> _10 t0a4inn COWRY PHpMC 0.400 S*fvfoes.Efti'Orrrrrenta!►1es1114WMIL L-20— Divbfon <br /> aafarl u'Ir `�.t ci r�r �t /usesfda <br /> PROPERTY Owrtef A,},,, -lr.�l—.,, S'rt t 4 rl r� r4►�d1.7a c� � ,, i `� -���� ci 'i <br /> b-if f rt,.lry h,zp %s t.l Pna.e. <br /> t _7 r x. 1Y A�, etr;)�jp�aaea_': _ -<� C.:. l <br /> Cons1/hr1 13u0 GOMreder 11:[ C z .1► .�i�•pa v,era 1 a r ✓r <br /> 613 Coordinates-X Y Towf»h{p Ratga_ — <br /> 6eG11en <br /> Il�Q�soO�r� <br /> p NGW WELL 1 DCA No I a'T. HYDROVUNCK HANDAuGER C TIER•) Q DESTRUCT1pN <br /> p NG! 1 --1-L (choose type below) <br /> D VYtLL w d OVER-SORE <br /> 'OOnr p PRESSURE GROL'r <br /> rt" <br /> COAWFISTS: <br /> L2"wim RMA <br /> ULA i a sprasMA <br /> 3 MONITORING p 010t-LDW STOA DIA OF SOREHOL! f11VLT1pLE CASINGS?DYES D NO WELL CASING OtA; <br /> p DURACVON p AIR RAAMAIR/pRIyEN CA2"THICKNE&S _TYPE fX CA51NQ. p STEEL p PVC D OTHFR �sefelA <br /> J O VAPOft Q MUD ROTTgY <br /> DEPTH OF GROUT SEAL_ TwmIE TypE TO BE IJS90: C AVGe,iS DItOSE rOAM <br /> p AIR SPARGE p PUS"_POINT oROvr WL NAVW: Cy. D Ne(NOTE:MAM MUNI FREE-FALL DEPTH IS 30,) <br /> 13 SM DORING 10 NANO AUGER AP'"OA BORING OGPT}I Q sOLTEp TRAFFIC BOX or d STOVE PIPE <br /> D 011168 t)OTHHR <br /> CONDUCTOR CASING PROPOSED?___�(K Y".Iter specAca funs here). /t <br /> ccu"FR": r1WJ <br /> NOTE- OFFSITE BORING$REQUIRE ACCESS OR ENCROACHMENT PERIOTS <br /> naw pre"va Inas ipp+reanon wo thal Its wwk sift ee done n acoord■nca+ren sen laaourl <br /> And Ptaquisnona dMs Ban Jaagv4j CoaKr. Hol."mrer or Ik*m a agent's agnstura prtiriFy Il+e foa&A 't c WOOS.Slati lava,arw ales <br /> for wftky,A Ja fpemgr la�r Atma"of �- *r'fY W W in O f pam1haw om at o m*)W r <br /> Y Post of to"fe"CReAFRS'compswuTmw Cara of Gfffa.,a-� Com lractera MtMp of svo- <br /> cronttac►Mq stD^�'/'e wt11Ma trw fOMowh+p:T c>wor^W Af at OWOTIann or"work W O.PWO tl'Iis aenwt)Id ntled.1 aflaN entoloy DerfOru auaJeet ID <br /> $ 0PJ(E!0tS'CQ4EEAISA rfQN Lewin or ria, <br /> EPLIC MT'MUp�T C 40 111iORK1tlti HRi M!A FOR At L REQtlIRt?D M►SPECTIbN6. <br /> owe. 10 <br /> SEE SITE MAP 'IN UNIT IV WORK PI 0 <br /> 04 DATE& <br /> 'csoO^ACeepaed 1r_ 1 <br /> /kDlP1tRt'IICHTUSE or0.r <br /> (ry`�inti!G h __Da*Is wed <br /> of"Irameoc t BY_--�-`=;k't, DMC / EMM ^apvd!•n <br /> t ( ^� <br /> Date <br /> OtaQuct on I n 8 Date <br /> CO1rfEefT's 1 t�rTlprri- <br /> ACCOUNTING 094Y: AIDS <br /> P!CODQb FE[two A000410y7 REMITTED Cf1Lef K w REVO WY DATR ►t711taTf yillylCti REQUEST f t1Wdt! <br /> d s a° , : 31� �o Zq q o a 1 0 0 <br /> Cd7 I2CFNSED to C OPL sTUN MIME <br /> tc�PO _ ,1ti4PENSA'I7bN DECUBATION <br /> VNLT[v-6/43/99/o'4n bi"IPA - ... ..-.- <br /> ZO0'd HSZtti 66/9Z/0L Tszs4t9tT4 ­ .I A <br />