Laserfiche WebLink
- - Page 1 of 1 <br /> _u <br /> Vicki McCartney [EH] <br /> From: Vicki McCartney [EH] <br /> Sent: Wednesday, June 08, 2011 3:45 PM <br /> To: 'byifru@craworid.com' <br /> Subject: 1313 East Charter Way in Stockton <br /> Attachments: MFR.pdf; LCD Form.pdf <br /> Belew: <br /> I have reviewed the permit application that you submitted for the well destruction of 9 monitoring wells associated <br /> with the Former Shell Service Station located at 1313 East Charter Way in Stockton, California. You have <br /> submitted only one permit application; however, there are wells on the adjacent parcel 15137008 so you will have <br /> to submit a second permit application for the 3 off-site wells. Missing from the permit application that you have <br /> submitted is the name of the drilling company. Please enter the name of the C-57 Contractor(drilling company) <br /> and place the license number of the C-57 Contractor on the line after Lic <br /> In addition to the second permit application, I also need: <br /> • A copy of the access agreement signed by the owner oft the adjacent parcel where 3 wells are located. <br /> • The Master File Record (MFR)form. I have included this form as an attachment. (Ignore the shaded area <br /> of the form since this area will be completed by the Accounting Department.) The MFR form is for billing <br /> .purposes. It is important that you understand that the Applicant Name on the form applies to whomever is <br /> going to be responsible for paying any bills that exceed the permit fees. If you sign your name after <br /> Applicant Name, then you will be responsible for bills that exceed the initial permit fees. <br /> . The Licensed Contractors Declaration (LCD). I have inclL ded this form as an attachment. Our department <br /> issues permits to drillers/C-57 contractors, not consultants. Since you are signing the permit application, <br /> you must have the licensed contractor fill out the LCD forr i and sign the bottom of the LCD that authorizes <br /> you to sign the permit application form for the C-57 licensed contractor. <br /> Please contact me if you have any questions concerning how to fill out the forms. <br /> Thank you. <br /> Vicki McCartney, Senior REHS <br /> San Joaquin County <br /> Environmental Health Department <br /> 600 East Main Street <br /> Stockton,California 95202 <br /> Phone:.(209)468-9852 <br /> Fax: . (209)468-3433 <br /> Email: vmc...__e...-art.riey�ij.,sjcehd cqm <br /> 6/8/2011 <br />