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11/20/2888 16: 48 19166385 CASCADE DRILLII, NC _ _ PAGE 03 <br /> WELL PERMIT APPLICATION FORM SITE <br /> MITIGATION <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES UNIT 1v <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) <br /> 304 E. Weber,Third Fioor, Stockton, CA., 95202 <br /> (209) 4683449 D <br /> d"""F01�?-'r r MC!�IT lXfllla 1 YLS!fleDal oaT!Iglr—^ <br /> Appkelon b rateby made in tier Jw Wn County M•pem*b omm Ct andW Malet h 7A111r deeOAad. This appluaeton Is rrfae in owMnahW eAM aan <br /> JpmquT Count'DrYJdnpnsMTtlt/. +rp„lae'fY1116.3 and a sw q"el San JovWm Cd1ny ftb5c hMelh awwlas, Frets OIWbrt <br /> WELLLuce/rn �tQyirrl�Z1 ;�. -G9farr8VlN) LcxllS Vy LAL406-)f <br /> 'n�t�t, _lip 330 Pawor <br /> PROPERTY Owner ' 0� 2c7� Add. U r)S 'CftrJ� *cly L4 6-)f, 23P b zcx-i�.e <br /> C47 Con -�rrte'' /� N 1� / <br /> ConaWtarli Bub ConTn1CW .T ecep A"lq�mg <br /> Gm Co nfrvem�)(_ -Y .TOMANp Rana modio'�_ <br /> LRL <br /> E W W EIL g7>1WC3 t CPT,ueomcM,Kyt AOfUNCH.K4ND.AUGM OTHER') R DmIrmucTi alb <br /> D L WRING► � <br /> lh <br /> n PREssuRE GROUT <br /> 'Other— Grew soedeCal Wr <br /> COMMENTS: <br /> =p OF WELL �lLAv7NTYPE F =--CW <br /> �,['� It <br /> �MDNR0PJN3 LOW SEN O W OF 6CASiNlj07 n YES. f .v WELL OAM'10 GNi�' — <br /> IJ EXTRAC-nou 0 Am vA aWlDRNEN G6N7G of CASiImm OCL 'G�C G�— — <br /> pVAPOR G MUD RQTAJtY DEPTH OFTRlM■TYP!TO as lW!lY.. GAuuena G NOI!! <br /> a AJR SPARGE GtiSH PONT GAOUT SEAL Pumpme G Y84 '2:�o (NOTE:NIWM UM FREE-FALL DEPTH IS 301 <br /> a9OIL BORING nHAND Wr�-R GROUT SPECIFlCATI <br /> a OTHER: O DTKE t APPRO:L BORING OlT OLTED T'RAPPIC BOX ar G STUA PIPE <br /> CDf10l1CT'OR OABIN(i PROPOBFDT I�10 IIIYQa,IVRepedlkatbrw hweT <br /> 'CIXAYQ�T3: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCE8S OR ENCROACHMENT PERMITS. <br /> CALL THE UNIT IV INSPECTOR 48 WOMNO HOURS IN ADVANCE FOR ALL REWIRED iNEPECTIONs <br /> I hereby rertify that 1 haw prepared thla application and that the Work will be done In accordance wNh Ban Joaquin <br /> County Ordlna utas and Regulations, and all applicable Cal foenla State LMna <br /> 04x-dT'w+cerep.,,y �S-4T�f�4 C7'Gz �G Q/'/ ��inJ <br /> �r GMa✓\ <br /> ,12E)FPARTMIrN I U15E ONLY <br /> N ( <br /> SITE M" IN UNIT FILE,ADDRESS: �� rS AT-Y I gel gib fe----DC-1-X.J- <br /> WORK PLAN DATED: a�g� <br /> appumkc Acop>b By Dm Wand C <br /> 3reut Inapec5pnSy <br /> pa„� Rnd kmpa0cn ar <br /> DeavtsQW Intp.dian <br /> =ONMENTa/CONDlT10M3:__ >%'rv� 7._U51U YD <br /> ACCOUNTNO ONLY: ADN <br /> PE CODES PEE INFO AMOUNT RBArrrUo CHECKS RCC'D by DATE PlRMIT l alRV1C[RlOU'Eai a leNtJlca <br /> 3� 2�-t I t 00 l3 <br /> C-57 Letter of ufhorizotlon to s gn PU mit_EncroachNurnt dot_ 9/27/00 <br />