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' 06/03/2008 12:21 4'09463'343z EHD PAGE 03 <br /> SAN JOAC IN COUNTY <br /> ENVIRONMENTAL ILTH DEPARTMENT SITE <br /> 600 East Main Street, tockton•CA 95202-3029 MITIGATION <br /> Telephone:(209)468-3449 Fax:(2 )d68-3433 Web:w,wi. ' ov of !ehd <br /> UNIT IV <br /> WELL PERM) APPLICATION <br /> NON-REFUNDABLE PERMIT EXACSAYEAB FROM QKrE ISSUED <br /> AppfiraBan is n by made to San Joaquin County for a permit m construct Or i.ta4 the work described. This application is made n mmpaanea with San <br /> Joaquin Count OOvebpnent{Tolle.chapter 9L tj7��S�and Cre Slatrdards ofp quin Courcy fnvu nl HnalLl OepanmeM. M 4u0-O� <br /> ' <br /> Wall LorafionIl)L S.I>lli ��apgT gytcl1i W city 6 .Lp Parc-^I At <br /> Props <br /> owne�{ ot �Jr o Cn Addrw 3530 ) mu I 1Q-1�c�_S�bc�h>n 2.p�'�Ph0rex b1D{-9�3$ <br /> p (� 92S <br /> asrConfnplprC Ya Itr Adtlross1�70 Cityr" Zp lkII 0510 PhD' <br /> %--, <br /> - <br /> conaald ahcnhrN'�AA4{,r_L Addmi,1 n IJ0G�y C WGA - U u Photo 59!fq-251-24ZA <br /> GM coordlmtes:X .Y .To,nshp Range - <br /> WORK TO BE PERFORMED: <br /> ❑NEW WELUBORI NO(CPT,r_OPRDBEHYORDPGNCH,HAN .AUGER-OTH ) t,�lDESTRUCTION(CHOOSP TvPE BELOM <br /> O SOIL BORING# ®OVER-BORE DIAMETER <br /> 0 SHELL# ❑PRESSURE GROUT <br /> C•OTHER 1/ •1' rr n I GROUT SPECIFICATIONS <br /> UpnaNe N-S._ I KIA M� <.-_ 14M PGr . INFO-Ex r Oca 4 <br /> T P*,OFWELL INSTALLA,y'' TION fPE - CONSTRU N CIFICIITiONB <br /> El NOWTORIRG AJHCL OW STEM DW OF SORE aZ ❑MULTIPLE CASINGS MULT.tEVB_ SYELL CASING DIA:2 <br /> 3 EXTRACTION ❑.aRh l.vwR10RIvEN CASUIGTW1 ES6&-40—.. TYPE OF CASWO:Q AFL IJ�PVC ❑ OTHER <br /> VAPOR ❑HUD ROTARY_ _ - - DEPTHOFGR I.ITSFAL S, TRWIETYPETOBEUSE01y�IJCERSLI)p56 <br /> AIA SPANGEWON=_ ❑PVs POINT(GP OR CPO_GNOIJTSEAL PED:0Yes Am INCITE: <br /> }rMAXMum FREE--FALL DEPTH IS 40') <br /> r..r <br /> SOIL BORING 0HAND AUGER GROU'SPECI CATIONS ILLC1 ctkpE- <br /> ❑OT<R ._ ®.OTHER APPROX BOR G.OEPTH 51 O BOL1EDTRAFFIC BOX OR <br /> ' COMMENTS�;1IQ 'To0. xcaa E - - ON <br /> PcrPDsp,ZtP <br /> NOTE: OFFSITE BORINGS REQUIRE ACCE AGREEMENT OR ENCROACHMENI PERMITS <br /> 48 WORKING HOURS NOTN: EQUIRED FOR INSPECTIONS <br /> I herby that IF. preTlamtl this apylicatton and Nal UW w tin wIB done 1 accordance with San Joaquin County DFAInames,Ruses and <br /> Regula o acd all ap�IAab Galiforgla ] <br /> Sgned 111lllif//11 Tal Company &t Joso At / L'A2$A 11 ttL- <br /> ' Print Name dr LLYe.'Ll 1 Dale 5.23-tDf� <br /> ll <br /> DEPARTMEI USE ONLY t <br /> SITE MAP W UNIT N FILE,ADDRESS:_17j�3��. ..TT +nf �)�t a� -�L 0.4- al 4 1V'.,.- - SI <br /> WORK PLAN SATED. oU `-- <br /> APPLICATION ACCEPTED BY DATE ISSUEDAREA XLI <br /> GROUT INSPECTION BY FINAL INSPECTION BY DATE <br /> DESTRUCTION INSPECTION BY �'. DATE <br /> CDBMENTSICONDIMONS: <br /> ACCOUNTING ONLY AND# FAC d <br /> PECOOES FEFINFO AMT REMITTED CHECKS RECV-D BY DATE PERMITISERVICE 0 INVOICE <br /> aa o)�. (0..0A u- IAL- o z oa ISR#' 6 <br /> C-E7 7 WC -WAIVER C57 LETTER CIE A' RMATION TO SIGN PERMIT ENCROACH..MENTDCC <br /> [n.^.tl[^, ltauT `HELL PERRIT.TFP <br />