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11/23/2004 09 44 2094683433 FIFTH FLOOR PAGE 02 <br /> qA5CAD1_DRT�LLING PAGE otl/k1e <br /> 10/20/2004 X6.25 J16638E611 ,,,, „ Y ..,. <br /> '� Y` LLman Joaquin County <br /> . iroaxnental nealtb DepartmeOt SITE <br /> NOV - $9d <br /> 304 East Weber Avenue,3xd Floor,S;ocMon,CA 95202 MITIGATION• NV1R0*QWKM f8x (209) 468 3433 Web www sJ90v,0nVct�d UNIT MN <br /> PERMIT/SERVICEWell Penmlt Applica tett <br />' N4oNA r-UwbnBLE PEPtiVIIT t XFiRP-S I YEAR MDE DA-M ISSUED pppp <br /> ApP�fs hertlby mads to San Joaq�n County for a pew to eorevurt w-wor Install the wow d mffhed t2�Ihis He�s licationis Dgprkmen�Ire compliance vAth Sate <br /> ,toacluin County 0evotopmsnk ritla,ChaptcC 31115 3 and t11e StBr1d of San Joaquin Go tt gsa+Cssvrs <br /> WELL Lot�tion �� s. � �^ i;,eppei Streot <br /> L–o a.% AvE City�� ZIP+=-� <br /> r C <br /> p�urtrer �L7 a �+_ AdOrccs nans4# �.w <br /> P 5. <br /> CA Qar.�r.o _"..r.-J' �1451p t Z - fro <br /> c.6r Cored actor_ n c d g ' i1L�io�wd�resa� <br /> Z. C�v�+c r. G�tx Cr� R� - 14 <br />' mfr 10.1 t` cr�� SO�G[ew+'��uav, pnonCR $I 6 7�Z 4 S�'1' <br /> Consuftant I sub Cntr V K %S <br /> GIS Coordlnatea Y <br /> 't'avvn^.!'e1P,.,. Rpnga Seeflore <br /> 1N0 pD~ TRUC1QN (hoasa below) <br /> ROPUNCH,HAND-AAUGER,OTHER-" <br /> NMW5Lt,1 BORING <br /> CNER-BORE. 0"ETER— . <br /> BOWNG r FMS`URE PROtrr <br /> GROUT SPECIFICATIONS <br />' a'Ot?tar <br /> COMMENTS <br /> ?, y�rMSTAt LA b 40g <br /> 1Y�E q%I UG �t:ca��a�tO r� <br /> dNtTOFttNfl ? 'g�iaLL17W S'firM 6tA vF t3OF2EHQ �S.r� "�IItk1LTIPLE CA51NG IL pe1ULTT-F_ L WELL CASING I71A � <br /> [3 EKtRACTiON /p PAR HAMMEPJDRIVEN CL0.5iNC 71liCKN k Ll D IYPF OF C,vy5lFtd p STEM D <br /> p VAPOR U MUR ROTM DIE"OF eRouT 9 TREMtE TYPE Td srz USED �1GERS q 0056 <br /> a <br /> A,F,SPAFtGB!OZONE 6 PUSH POINT{GP or CnGROU-r SSAL PUMPED'lam U No (NOTE*, MA)U MUM FREE-FALL-DEPTH IS 30'} <br /> t�tL t34RFNCz !7 HAND AUGER GROUT SPECiFIGA'YIONS�_ <br /> I]OTHER 11 C5TY1ER„�.r, APPROX BORING DEPTH 7f a -rr 0L'MD TRAFFIC pox or U S70VE PEPE <br /> CONDUr,TOR CASING ar2OPOSEO (t YES,Ilst spmVicabom m cotrtienent pentlon) <br /> NOTE: OFFSITE BORINGS RE UIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HDI.IRS NOTICE REQLHFtED FOR INSPECTIONS, <br /> I hereby cort1fy th2x 1 have repar+ed th appli catlon and that thO w6rk Will he Mone 10 a000rdance with San J`03gquin <br /> Cotanty Ord] ces, Rut mnr d 9u ons,snd all applicable Cattfatl3la State taws. ! f f <br /> Print Nstn-„� ....�.lr�/ Data �� A <br /> DEPARTMENT U9E ONLY <br /> SITE MAP IN UNIT IV FILE,AL_DRESS- <br /> WORK PLAN DATED � 0 <br /> ApF9casan Qted SV Daletaaued 3 ._Are <br /> (;rout Irapectlot)Csy. _ _ ate_ naw htspecwn I9Y <br />' Deatruotlon h%Pec an B l78itm <br /> COLSild6N'('w I'CpI�WT1Q>fi3, <br /> A=OUl%MNG OM1' AIM IFACA <br /> �13OMTSERVcE R�UEST# ta4G: <br /> PECOES FEEINFO AMOUWREM"ED CHE K$ REQ'bDY <br /> .SOI o I SS SR-4140 a <br />' C-57. Wt WAIVER C-57Letter of AUthar}zaiion to mgn permit_Fnavachrriont dnc,— <br /> f <br />