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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT SITE <br /> 600 East Main Street,Stockton, GA 95242-3628 M11TIGATION <br /> Tokphaf7e.(2(19)488.3449 F'iex:(2N)468-.U33 Web:fn*.sb v._mktid UNIT IV <br /> ik <br /> WELL PERMIT APPLICATION <br /> NDN-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Appkallon b1 hereby made to San JOaquln County far a pwnk to Oanstuct andlor Install M work dem ed. This applicadon Is meds In omplknca with San <br /> Joaquin Comty Development TIG*,dmWW 9-141"and to Slandards ol'San dompin County Fanihlnlun"Health Dsparttnent. <br /> Vkd Location I1�0 C"M'm C��11CtFk-Timmy CAY z��Pa <br /> DrrrleraamvL5� Addles, clty��r�r� 71p�Phpl** 7aF3 3t <br /> C-5T CaIlf.k.'. EXRW ' Omn 4bt-je cnQr -��� Ll.if 851gPI,gn*9�5- 313 SSOo <br /> Cormumb ntfftboCr& urr Ph-mqw---�9t!I$ <br /> GIs Coonamabo—X Y ,Township Rasps SeOtlan <br /> IWORK TO BE PERFORMWD: <br /> ❑N I .GEOPROs6.H DROPUNGt•NANO Mk OTHER) X. TION AMETE(CHOOSE Tem.Owl <br /> r3 SOIL&OR0`0THEIR --WELL 0 GROUT SPECIE CAI Tno <br /> GOWENTs, WI-q 11 2.)3.t(-6P�.1� 19 2.n aq M.__VM -1,�Cm *SUa--1 <br /> �.�... ...,..n ��--,�-7--F–� t�T - 1/ t2. <br /> �os=t+IlE1L - <br /> P(MONITORING 0 HOLLOW STEM O&OF OOREHME [p kliTIPLE CASINGS 0 MULTI-LEVEL WELL CASING 0 -_ <br /> i <br /> A EXTRACTION ❑AIRHAMMERI PAMNl CASING THICI0 ESS TYPE OF CASINO;0 ST MEL Q PVC O OTHER <br />€ XVAPDR ❑MUD ROTARY pePTH OF0KW SEAL r TREMIE TYPE TO BE USED 13 AUGERS 13 HOSE <br /> AIR SPARGE30ZONE ID KW POINT(GP OR CPT) GROUT BEAL PUMPED!Q Yee 0 Na(NOTE:MMMUM FREE-FALL OEM 0 3W) <br /> [3 SOLeomw 0HAND AUGER GROUT SPECIRCAPONS <br /> 0 OT1fR ©OTHER APPROK BORWG DEPTH SOLTF_D TRAg7C BOA On la eyove PIPE <br /> GaIra11C7GfrCh5lrldPFiQPD6BD pr YR•rw ap�elk�ora Fi m�e wClpn f <br /> COMMENTS; <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS <br /> 41 YMORItING WRINA Well MUD FQR IMBPF.CM, In <br /> I hereby onvaly fiat I FEWfiYa ap and flrat fhr mark w E be donor 1 accordsoee vMh Bien Jumpin Co"Ordhranou,Robs and <br /> tsyulsnons, ; <br /> Slpnlyd �% 7NIelCarrpany nre '6/l"/ <br /> 1'rEnt Narrle T-� CAfI Dave ! <br /> DEPARTMENT USE ONLY <br /> f SITE MAP IN UNIT IV FILE,AmRess. t (SCJ 3 r2' s +%At t A _ - <br /> WORK PLAN DATES:T� i� _• __•— _-- <br /> APPLICATION ACCEPTED BY, DATE ISSUED AREA <br /> GROUTINSPECTION BY 2 3 FINIAL f; INSPECT"BY DATE CD DESTRUCTION BY ll`�-�/VL.`r� DATE._ _f5! 2 3-2 S�(C7 <br /> I COlrttafsnTSNCOIIemala: .. ... <br /> ACCOUNTING ONLY: AID N FAC M <br /> PE CODES FEE INFO AYT ilElfl f ED CHECK 6 RFCV'D dl( i' DATE, PiRYITIsIJERYIC!R MNiYDICE <br /> 3 SaZ 3Yr o0 o&v Z3 6 i la 'SR# 605 <br /> C.57 WC -WAIVER C57 LETTER OF AUTHORI TION TO SIGN PEFWT EMOKIACHMAENT DOC <br /> EM 2"f S lj&Di(vvm) VAgl FERMm APP <br /> FILA COPY <br />