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06/15/2007 08: 47 92531. ' GREGG DRILLING PAGE 01 <br /> JUN-15-2007 09:52 1WCAfhBRIA <br /> X707 935 6649 P.02/02 <br /> San Joaquin County <br /> Environmental Health Department SITE <br /> 600 E.Mein Street,Stns,CA 95202-3029 MITIGATION <br /> (209)469-3449 pax:(209)468-3433 Web:www.sjgov.org/eW Z07Jr,U NR IV <br /> Well Permit Application sA�-t1� . <br /> NOM-REFUNDARUE PERMIT EXPIRS9 7 YEM FROM DATE IRRUED ,��Tv;RQ�hE COL, r 1- <br /> Appllh#tlon to hereby made to San Joaquin County fore pemm to construct andtor Install the work described. Thle apptic�lu�1 Barbs with San <br /> wntJoaquin County OavetcPment Tide,Chapter X1116.3 and lite Slertdanla of son Josquln County ErWromnenisl Hoafth Depart <br /> MLLLocadon 4�est Ltittrv{oY. W4•� CrovStreet ; _Gry—�6:1 "�1—Z� oroeN 16Sr�/QD-I <br /> G2Q Wesi ChartQrW LL G30 , y1�a vesanrn leo <br /> PROP icf�Y� _ <br /> t>rlhner � .QM�Ss 7 <br /> �c��9e ews,+.l Svc. �drhhu�q,9S4 Nau7k c�uv� L)*65007honoo Q2,--7/�"iMev <br /> "7 Cant r_ <br /> cm.um"11subcntrCs,s eQ'QovCcstA4�ci� ddnsni4k9� Riyef�jrPr'Sv a�DatySsMee�a� t Pnnnes�5??� X339 <br /> GIs CoodinQtes:xL Y Township Range Seek <br /> b NEW WELL I BORING (CPT.BEOPROBE,HYOROPUNCH,HAND-AUGER.OTHEM 0 DESTRUCTION (dtoose type below) <br /> �.SOlI BORJNG s�,P r- R p OVER-BORE DWt1k PER <br /> o u, F E c o Y GAOLrT6URE GROUT <br /> GROUT SPECIFICATIONS <br /> COMMENTS: <br /> MMUS6,16 twsreLLATION TYPE CON9TRL1C7fOlt§FCCIFICATION8 <br /> 0 MONITORING p HOLLOW STEM DIA.OF WREhOLe,�K„ 0 MULTIPLE CASINGS a MULTI•L6'VEL WELL CASING Dia <br /> d FXT'RACTION d AIR HAMMERIDRIVEN CASING TKICKNESS_wj& _TYPE OF CASING: 0 STEEL O PVC 0 OTHER: <br /> p VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL TR6MIETYPE TO BE USED; )AUGERS ff HOSE <br /> p AIR SPAROPJ OZONE*USH POINT(GP or&rFIOUT SEAL PUMPED: Jos UNG (NOTE:MAXIMUM FREE-FALL DEPTH 19 30') <br /> SOIL BORING fa HAND AUGER OROLrr SP=FICATIONS O_- 16 1 <br /> 8 OTHFJ�:_�!I OTHER APPROX.BORING DEPTH�Cp� a BOLTED TRAFFIC BOX or 9 STOVE PIPE <br /> comDUCTOR CASING PROPOSED 6/0 (Ir YEB,list epedflcalfons In comment section) <br /> COMMENTS <br /> NOTE: OFFSITE BORINGS REQUIRE,ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOVICE REQUIRED FOR INSPECTION& <br /> I hereby cert! that 1 have praparod I applICAtlon and that the wort Wlll be done In accordance with Sart Joaquin <br /> County Ord! n, gu ons,and all applicable CalNoml Slate Laves •� <br /> TalalCompeny <br /> Stpnee <br /> / \ Prtrtt Name au as, cls tX f b <br /> i <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT!V FILE,ADD 9: O e C a <br /> WORK PLAN DATED:`/ c d <br /> Appl[cWtn Aampled B V i 1 r f n e c Dole Issued s 7 ..__Ama_j-45-17 <br /> L <br /> Graft inspacgan By.,, I' Gti Dain 9 / - InN Inapaetloe 8y s Geta 9-/2 -t7 7 <br /> Oestrudion Ina on By <br /> COMIIEMTs!t?ONDII'1ON8� V Q Yr tC'�" I R <br /> ACCOUNTING ONLY: AIIX FACS <br /> Pi CODES K INFO AMOUNT REIMITTlD CHECK l RECD 6Y !SATE PEMI M I SOMCE R60UEv a 1NVDIt:E <br /> 3501 �89,ao 89,.00 IDh{r5'7 S� �aSfo�o <br /> C-57 WC,-,,,_,-WAIVER, C-57 Letter of Authorizatiott tv sign permit_Encroachment doe_ <br /> vD 2Mz-W1Web <br /> slats+ <br /> TOTAL P.02 <br />