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APPLICATION FOR WELUPUMP PERMIT <br /> SAH JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTR DIVISION <br /> P.O. BOX 388 304 EAST WEBER AVENUE, STOCKTOM CA 95201,388 <br /> (209) 468.3420 <br /> XON-AEFUROARLE PERMIT EXPIRES i YEAR FROM DATE ISSUED <br /> IComptrt•In Triorintel <br /> APPLICATION M SFERE SY UADE TO TUE SAN JOAOIJW COUNTY FOR A OER"T TO CONSTRUCT ANOIOR INSTALL THE WORK DFSCWREO-THIS APPLICATION IS MAGE M C04PL1AFICE WR/t SAN <br /> JOAOUIN COUNTY DEVELOPMENT TITLE CHAVTEH 9-1115.3 AND THE STANOAI1nq OF SAN JOAOLIW COUMTYs(J&M"CALT�N`SEON <br /> SERVICES,ENVFUENTAL HEALTH Drrt910N. <br /> O <br /> JOB AORESS/OR Alltel. 2908 Benjamin Holt Drive CITY s��4G-{W" <br /> I PARCEL 9IZVAPN. <br /> OWWER'X NAVE ARCO Prod 1 .s .o1 ' any AD()R[SB T\qNE <br /> CONTRACToa SR('()R TptPY' ati nasal ADOREB99912 Business Park m, 58399 P"O-4 <br /> 1OBCoNTRACToR west Hazmat Drilling Corp. ADr1M.tB 3233 Fitge�..rnnald Rd C57 55497915 <br /> TYP'�=IF WELLJP[JMP YV W <br /> ❑ NEELL ❑ RF (/� <br /> -DC F7+ENT V.TLS. %0k-0-"O-Nn WELL/�Lr .r ❑ OTHFF% <br /> ❑ N8TALLAT1CN ❑ WELL SYSTEM FTV-R ❑ CRORS-CONNECT REPAIR ❑ VAPOR EXTRACTION WELL/ J <br /> ❑New❑sta,.t, N,P- OF 17TH-J NP SET Tr- FTRLT WATFR LEVEL 0RYPf Oo�PV UPI <br /> ❑ OVT-OF.RFRVICE WELL ❑ OF,CI`11YS1CnL WELL t D SOIL BOTPFIO R <br /> ❑QESTRLICTION- <br /> WTENDEO VEt rrP>E OF WELL CONFTRL PCTION ZvECIF1CAT{ONA ' <br /> ❑ tT10UBTRIAL ❑O!'ENBOTTOM DLA,OF WELL EXCAVATION D1A,OF CONOI/CTORCASINO O <br /> t <br /> ❑ OOI+E9TICA>•+lVA7E ❑Gti/1VET.DACKtATLE TYT7 OC CA-t+ti/tiTEEIJP+Ic VC L4 � D.A.Of WELL CAsnm O <br /> ❑ FVBLIC/MUMCWAL ❑omww CCM 14 OF OROUT DEAL S LR'CTACATION A <br /> ❑ JRFRT;AT'om'AG ❑OTHER GROUT VFTt.tt(rrA(.LEO SY Q1pUT SRAW NAME E <br /> qp MOtRTORiNO ��/ cpt VT 81FAt.RI"OVO: 13 y- ❑I+. CONCRETEPEDESTALBYDMLLftt:❑Y.. ❑NP S <br /> APeROA-OEWTH LOCKING CNE97ER ROXMTOVE PIPE_ <br /> / S <br /> TROSOCEO CONSTRUCTTORlDMUJM0 FMETHOO: LIVO ROTARY AIR nOT ARYAUC'-fIL CAI!LE OTHER <br /> I HECESY CERr*V THAT I IIAVE PREPARED TH1B APPUCAT"AF O THAT THE WOW RF DONE M ACCOFOANCE WATN LAAI JOAOLRN COWTY OROMANCES,STATE"V49.ANO RULES AND <br /> AEGULATIONP OF TW SAN JOAOMN COVNrY. NOW OWNER OR LtCENCfO AOENT't"-WATVRE CERTIFIES THE FOLLOVANO:-1 CERTILY THAT IN TNF PENCOMAANCE OF TIIE WOW FOR w'CH <br /> T119 PEEWIT IB tSBVED,I SHALL NOT COArLOY F-Enco"WJRJFCT TO WORATAA W%COUPCOMAT10N LAWS OF CALIFOAFaA- COT(TRACTOR'S FUFWM OR BUS-CO"MACTTNO BIG'ATVRE C£RTWIES <br /> TME FOLLOWING; 'I CEMFFY THAT Al TILE PVRFOFW ANCE OC THE WORK FOR wN1CH TMC rtFm-rr It 194UM,1 SHALL ETAPLOY PERtONS SU6JECT TO wQstOMAN•s COMPSURATTON IAMB OF <br /> CAUFORNIA.- TOE ANT FAUST CALL u NOtXtA IN AOVANC1(FOR ALL R'EOtRAVO rm"'gCTtONs AT 12es1 ARSJA47t, COUFIF'TE DRAINING AT LOWER AREA P/bVIDED. <br /> N ^ ,n <br /> SIC-4 X TnI. f�s S O L(<yFC- riV��ea,.-- <br /> ROT ELAN R)..-.to S+N.1 Pa— <br /> 7. NAMis Of STREETS OR PO 87 TO OR SOVNcoNa THE ProirfpTY, "'�CTT� <- LOCATION Of WQJM SLµrA(;[O1BpOSAL STSTFM OR ED <br /> 2. OUTLINE OC THE PROPET ry.Omn"a Dcwk""O"S AND NOFrrH OcmCTION, EXPAA&S"OF SEWAGE OtOM9AL*YSTEUS. <br /> 3. OR/E"WONEO OU'ILINF.B AND COCATgM OF ALL F> VP40 ATO pF\7CY)5E0 S. LOCATION Of%VCU&WFTHMr RAOIUB OF ONE fT_ <br /> STMJCTVRES_INCLVONG COMM AREAS ISVCN AS PATIOS,001VEWAYS,ANO WALKS, ON THE PROPERTY OR ACUORRNG PROPERTY_ <br /> vAfto <br /> OEFARTM(NT t121 ONLY <br /> Aepbe.lte.Aee.e[dI Br 01 L� <br /> G'v I.—r Sr 0.1. Ptsno M+.p.ctt.n By 0— <br /> tr.P.Plt—0r OST. <br /> ACCOVNTNO ORLT: ND/ PACs <br /> PE CODES FEE INFO AMOUNT RFTArTTFD CNK lCASN RICIUVED SY DATE ?jjWAFT1sHNIC£REOUFisT kX*W9ER INVOICE <br /> JoS C)C) 1� <br /> Pub.Health Sam-Emriro.173(3196) <br />