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96/1Bf2Bf33 e8;82 289 583433 FIFTH FLSPASEBa <br /> IWELL. PERMIT APPLICATION FORM M SITE — <br /> SAN JOAQUIN COUNTY MMATIOM <br /> ENVIRONMENTAL HEALTH DEPARTMENT (END) uNrT IV <br /> 304 E.Weber, Third floor, Stpektam,CA., SS202 <br /> (209)468-3449 <br /> wn, f71'Ri PAII' TF 1A FROM r .teatt� <br /> 1ppum4ion Ls here�r n w Son JoawArt Ue� Iy*r a�t m mnssvt3 ut►dlWh ta11 tie t3ecealbeo. ,ni a aoplimtlan in evade!rs eenepdehaw,r•ilh Ban <br /> foequin CesmH L1p,.inlopmgnx�111a,C]�oeegr 5.7178.3 q�td 1 e 3alnderda d ban.l�quin CwA�1 EfHiron�>7entsl He9tlfT pitlitrr�llL <br /> nr€L�1,+yexrlon f�atZnao� Q�.� v�- s G 0.„ c)sy s le rk4w, app 95otij 3��r��� <br /> SROPF118TC miner=5�T'�- L.�Cd'Hcc,AdE�ss � • 4� cl�r $�a��a n 5,`�'7a�'Ph�,_ _ _ <br /> CJsr eontr�rJorW ,rN��.'��1�i aei+� 1 i�r�earf �.s�ct._,e.���+,1f�Md zIp4S� � �fO�Phenea ��a- 66z-15�� <br /> rnmvhmt I sols tally LA�i —0 'r&its kV ,4idroa,n a v Cz �1+�i S o-r�uaK �,IU' hana.V <br /> cis ceafdineta:w_ _ .1..r .7 hip_ <br /> &M agtgRr_g8W& <br /> v NIEW.WELL J BORING (CPT.GCCPRCBE,HybitOPUNCH,HANe,AUG1:R.DVWERy 0 DES TRUE.' ON 10a c"belmu+) <br /> A solL eowN�9P - n aVER�80hE CIAM6YER�,,. <br /> n•w+er �Vwr TBIMCIFI A IONS <br /> CQMbJIEI'1 T5: X20_ vl t+lv✓L. <br /> TxpEID�R (ALL �N57� CCKffalijupam spreME&TJCN 11 <br /> ufONITGRI1yG IoLLaw 9Tsw nW_OF aaRENOLE _ LILTSPI q casIN+35 D MIJLTi•LKViEL WELL erAs1NG DUa 2 <br /> p E=AC7I4N IS AIR HAMIV19KORIYEN CASING THiCKNMA J" TVK OF CABpu4W, G STIML XPVC' a GTHER: <br /> 13 VAPOR ri MUD at=A1sY VW2T"OF GRGUT SEA>_ 1.W_ 7REMI1 TYPE TC RE LA901 0 A U6EM Q NOSE <br /> DAIRSPARGE/OZDNS pPUSH POINT[GPorr.Pj)i41tOUTMAL KWINRp: QYes +f No j111CVM-.UA�i MUM FREE-PALL DEPTH IS ac) <br /> a SOIL DORM (]HANbAUGER GRCKFT Sprorme"CINS 't' <br /> 1]v7H1rR: tl O1'HER� APPRWL WR1MG p"TE13"rPAWG BQX Q a 3MVE POPE <br /> CoNDUCTM CAsINg PRaptawD! of TER.W spediie*Dmnv in mmmwd aedan) <br /> C4MFIL;'KTs; <br /> NOTE: OFFSITE BORING$ RE011.11RE ACCESS AGREEMENT OR ENCROACHMENT PERMITS- <br /> "WOPJUNrw <br /> ERMITS."WOPJUNG HOURS NOTICE REQUIRAD FOR INSPECTIONS. <br /> 1 hereby eek that I haVe prepared this appticatlan and that the Work WWI be deme in accardItnce With 322 Jftaqule -7)County Qndt, ter.,Rulm arfd RagutatiarrN and all aoplleable❑aliferrlla Statile Laws. <br /> Signed x, C <br /> print NFT r `fir t.l '&O Z-45Pc Qate l I - _ =i — <br /> 9�ww Use gmLy <br /> Sl'1'g MAP IN lJNrr IPV FILE,AOp 8— Ca L n <br /> WORk PLAN DATED' <br /> Qrwt Iropedon R!+ ill tnxpRetlen by <br /> _1] rt 11i=p 2n 6Y Daae <br /> c�lWattTs r eattlplFlBItIS• <br /> ACCOUNTING QNLT: ANO <br /> pE coD6R 1 P arRa AN+a<tid7'I7f�Tr� C cK Rl;CD 7' BATE RI%Mrr I SEXYZE ItSgUt55t Ila+iaK6 <br /> 35v 1 00zIwzz r( Ko SR# 0O 35� <br /> -57— l+ G_,.'WA1VEit C-67 Letter of AwTherize:fyaN to sign pertnit _. .Eneroarhhnentydfl� 9/30/02 <br /> Z06+� Sim 00688t9 BTB TVJ RIM BILL eai -OlTT <br /> Z00z S2111 00696L9 9T6 XVd OZ:ST HILL EO/ir0/TT <br />