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FILE COPY <br />�i SAN JOAQUIN COUNTY <br />NVIRONMENTAL HEALTH DEPARTMENT SITE <br />800 East Main Street, Stockton, CA 95202-3029 MITIGATION <br />"Al <br />TfIpydw: (209) 468-3454 Far: (209) 488-3433 Wr6: www.sioov.ora/ehd UNIT IV <br />WAM WELL PERMIT APPLICATION / _ <br />IJ -,REFUND R! F RutT p�wrxFc 1 vveR Far1r,A W.TE I�- UEO O I V CP <br />ARO=uon Is hereby made to San Joewin County for a permit to ow amms andAx Yvfall Uhs work described. The appiowson is made In c9mpaance with San <br />JOWuin CMIMY DevekrpmerX Tills, rlhaPMr 9-1115.3 and the Standards of San JoaprN Cotaty EnvkerwrAnW Mesh), Daarhaent <br />Aasassols <br />Prowty tlon 1717 S. Center St- Cross SlisM M 3rd St. City Stockton Zip 95206 Parcell) 165-072-26 <br />ProWrTY <br />Purer Ismeel Rivera Address 1717 5. renter St CRY Stockton Zip 95206 Phoma 2n9-462-1374 <br />C-57 Contractor Gregg Dri I lino Address 950 Howe Road City Martinez Zip 94533 LMB 057485165 9Z 3313-5800 <br />Consukowju*Cntr PSC Mtrass2/0 M. Ssud Bank Rd. City Columbia Lka Ph" 618-281-1543 <br />GIS CoordNness: X 37.93% Y -121 .2A6 . Tow tsNP _ I N Range 6E SecWn 14 <br />WORK TO BE PERFORMED: <br />0 NEW WELLIDORIMO (CPT. GEOPR09E, HYDROPUNCH, NAN0.AUGER, OTHER -)DESTRUCTION (CHOOSE TYPE BELOW) <br />® SOIL BORING/ Cd r <br />PT -1 anot-2 OVER43ORE DIAMETER <br />O WELL a ❑ PRESSURE GROUT <br />El •OTHER GROUT SPECIFICATIONS <br />❑ EXPLOSIVES DETONATING CARD <br />II2i OF WELL <br />❑ MOMTORiNG O HOLLOW STDA Oil OF 60REHGLE 2" O MULTIPLE CASINGS O MULTI-LEVEL WELLCASING obi <br />O EIRRAACTKIN O Am HAASAEPIORNEN CASING TTaCXNESS TWE OF CASING: O STEEL O PVC O OTHER <br />O VAPOR ��`13 M''' VD ROTARY �rTH OF GROUT SEAL T.O. TRBEE TYPE TO BE USED O AUGERS O HOSE <br />❑ NR 3PAROEA7ZONE $ PUSH POINT (GP OR <br />�\ CPT7— GROUT SEAL PUMPED: O rw ❑ NaN• (NOTE: MA7WIlp1 FRE6iALL DEPTH W 3C) <br />SOIL BORING HAND AUGER GROUTsMKwrcAT10H5 Neat cement <br />O OTHER O OTHER APPROX EORlW DEPTH O BOLTED TRAFFIC BOX OR O STOVE PIPE <br />caouctvR rAasre MTs. w w•ak~, h w•mra r cloy <br />COMMENTS: 2 CPT borings and up to 6 hydropunch borings and uo to 6 so 1 or hors <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS <br />45 WORKWG HOURS NOTICE RECAMWO FOR INSPECTIONS <br />I hereby cwft dw 1110000 BW appacaRan Md *het Ow wwk wM be Oewa I aaaordah•p with 11" Joa4W* Cal" 010,,Ia ass• Rule sad <br />aFi M laws. <br />i <br />SW.d I Q�`�—� TIEalCamperry Pro act Manager <br />PMi Noma Paul Anderson Dab I // ZO/ <br />P D�Ga� <br />SITE MAP IN UNIT IV FILE. ADDRESS:zzzz .5'. , <br />WORK PLAN DATED <br />APPLICATION ACCEPTED BY _ <br />GROUT INSPECTION BY <br />DESTRUCTION INSPECTION BY <br />COMMENTSICONDn90NS: <br />FINAL INSPECTION BY <br />DATE /-/,P-/U <br />vv v — ./ ENCROAC/N/ENTDGC ,i//r <br />END 2 l lixts, B T— W PERMIT 'AA 7/ 7 <br />FILE COP <br />