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rHuc G� <br /> L;pStiiallt UKlI_l-1NU 1N1. . �TT <br /> 11!20/2000 16:48 19166385F" Ise esc aa+ �t��\Y'1 <br /> WELL PERMIT APPLICATION FORMSITE <br /> mmGA11ON <br /> SAN JOAQUIN COUNTY PUBUC HEALTH SERVICES UNIT N. <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) <br /> 304 E. Weber,Th 9)or, n, CA, 95202(Y048oc <br /> •awr exrwEti,YaAR F�x�aJi1S/Q r wab ti asnaP/rHa a E lae <br /> Aooloaaer h MraEr wwea L Ban leaa.B't Oo�rM M a o+E++lr <br /> Of mvavSan da"Quino n+Nor Co a.ork Ea.alb.e. T11r aPDa�" Fran fEaY� <br /> ,tonQuM tAtvtO•Darak'DElan1 Tltla Chapter a1110.i nc the BW Ws .CMn County '�,,_Ilrltl,Dtn10�.BMcva*�� <br /> '�533 D.woi. <br /> NtI.L Luoo tern + s"`33 M <br /> tyy <br /> HN£ <br /> ►Aa►ERTY oen�e1 <br /> Cat <br /> Gcwwnnl r a+n ta,nr.�r •-�-T Cf*�P A�'w <br /> eIa ooaer;.r+ic x Y_.1.---Towfkk <br /> ►ERFOMIla: D DEQTRUGT10N Maas 0"b~ <br /> ri W ELL/BA RrO f L�OKTiORtIA11p�IO Hi 07"e <br /> Pr) <br /> BOfONM o <br /> _pre,t ip.ere..ana* <br /> atrn <br /> COMMENTS: <br /> TITI of Ydu NaTALL,TON MEvm"CAN413 m;.-?-L <br /> �(IJON70RINO -yw� �y vrEm DIX OF BOREHOLE MULTIPLE CASW#GW 0 Y1 1 <br /> D�—- ID CArN G TTBCA EW TYK JOF-CABIM# D BTe[L Dam---- <br /> :I EXTRACTION CIPTI1 Or OP40UT a Z TREME TYra TO YI"M DVOW AD"M <br /> D VAPUM D MUD ROTARY <br /> D AIR SPAAW D s"POW ORCUT 55AL PUMPED' Dy" <br /> �ia (NOTE: NAXIN UM FREE-FALL DEPTH ID�o <br /> Pis" <br /> SOIL SORe4G DNMNDAUGFR OROUT SMCIFCAT101Na• T®TRAFFIC a= M aSTO�►W[ <br /> D o mat o otwaR Ap►ROX ammo ofsrn Y val iw apK/api{p f rl1Y <br /> CONDUCTOR CASINO►RO"EDT�_ <br /> -cavern: . <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br /> @IiPECt10Ni. <br /> CALL THE UNR N INSPECTOR ii WCRKINO HOl1RS IN ADVANCE FOR ALL REQUIRED <br /> I hereby t>vFwy l 1 A pnpand Ihla apPNoatlorl and 016t 111e woltcwiY be done In acoordanci with iEn Joaquin -/ <br /> Cour+y Ordl s, a and Repulatlons,and on appflc+b�G�I�I��1i91* <br /> 8ipr+d DttY V //��O 'L! Q -L J <br /> Mnt Name t✓ NY A <br /> T <br /> SrrE MAP IN UNfr N FILE,ADDRESS: - - <br /> WORK PLAN DATED: <br /> ,pPic w Ao—rd Fret tnapwsoeI By �'?AT P' <br /> 3,wltiapacsw my °'°' ILS. <br /> )Iatractlon In dim Dara <br /> �tiaN <br /> nT4/coND <br /> ACGOLRFTeKi ONLY: Ail! <br /> PE CODES FEt INFO AMOUNT REMrTTED CHECKi vmclo n OATS <br /> IfRYR/i�RY10l RlGVaaTi INVdCa <br /> Gp �, 3� ti (prrrn 9/27/00 <br /> C✓577_ WC__WAIVER__ C-57 L.etler of Authorizotion to pi it_Encroathmsnt doh_ <br />