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07/18e2000 TL'E 13 30 FAX 916 777 4101 4 W DRILLING INC �U[ll/npl <br /> ,a• <br /> {1 07,'l8r 2000 13 22 1209-57025 kicDEr.10 A1C 0 PAGE: OL' <br /> r� 1 t-;36-i 55S 1 id i 1 AM FROM p A <br /> ' r <br /> . - WELL PERMIT APPLICATION FORM UNIT IV <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH 5ERVICES <br /> ENVIRONMENTAL. HEALTH DIVISION (PHS-EHO) <br /> 304 E Weber, Third F1aor, Smckton, CA.. 95202 <br /> (209) 468.3449 <br /> N.AEFVPI0A9LL9 PERWY EXP%t S 1 rSARF 014 0AT IS <br /> AWp CMIW Is hereoy nada to San roa¢irn aunty ar a oormx to cansuusl rrr4lvr•+stall Qsa cork a•a Thn+1PPix:a0oP 1%mads .+Cernpt anre wuh <br /> San roegwn County Deuelopmonr T41• Ct aPtef q-t19S 3 tt{IU•ne Stantt�rts•of 5,1n Jvsvlla Gouty PybYt Melattn$en�ces, cf5r3rnrsrtcttt:�n4ait7 p.aStn <br /> WELL:station rocs 5t>,aeter^kStin CJ1yrF..1�Yr,n 71fli Py+ah.�r s -- <br /> F`ROHERTY �w••sr 4aar..s„ f��Q�.fA�� 1 c>lr- -�'c�oL-.. "o norwK ,Zj 1��!!kLtj <br /> C47 Contuaetow li4 w tet,I l.+%t Adoraes Barr SI � C h + rrY�•�L+e�7 to vnonedr_al�lie�-Tr�Z'r^�fOC) <br /> Coase+llarnt,S+fa Canrteesor G 0. A4dras4 Il 1-1 —m SS*e Cayxar Z.IU PhOnts l <br /> airs c0w*+atas. T,•37,440 V t4 ZA• Z.3 4 r.I <br /> WORK TO ar Pf!E251!� <br /> Xm1w WELT_1 BORING(COT GFCPItQSe HyDp0PUNCH �+ANo AUC-ek OTHER-) 0 1IESTRUC110N tchoosa 1Yp6 to <br /> �a60lL 9CRINiGAI0 OVER.GOR>E <br /> 't3thalr <br /> A"U P 13 PPESSi3RE GROUT <br /> COMMENTS <br /> DmL2v ELL I113TA"A71gg T-f N&TRUCT16N FICATI <br /> *ONITORINO ,>"u.0w STEM DrR OF POREHOLE--S".�muLrla�-E CAv""?v YES XNO WF-LL CASINO DLA 2-11 <br /> a EXTRAC-l7N a mR HAlWaIr•RfiRlvfsN C.A$1NG>�'IvFW_95�4-TYPE ?F C.4bINCs U S T E£L XPJC U ZTMER <br /> a VAPOR a 1MUC ROTARY DEPTH OF opkovr SEAL g TRFMIE TYPlf TO BE USED a AU 3EitS j�osE <br /> Q AIR 3P'P1+t5t a"M PQINT GROUT SEAL P4MP9D' xyts a No (NOTE MAMALM RfZEE-FALL DEPTH S 30') <br /> D=11 6VLING 0 191NO AIME1R APPIROX 90WNG DEPTH 30 —Wa_ <br /> Q vm9R - !]C7MER�T � C4N17UCTOA C.aS1N0 PROP03EC4 6 ItYrc TF1]7F[AiFiC 9(3X ar Q STOVE PIPE <br /> �_(rt v€5 itai apeCIisCaSc.+i fora) <br /> CQ1YtARt:N75 <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS <br /> 1 -4 0ty Oari*f of I hy1w4 i ftpwcdJoaquin 0 ipDti�illOn ertO trier Ulu i X Q%7. a M zr40'tianw w3M San roag6jm County 7�arrras, late Laws and Q= <br /> los <br /> Rapyiada+s of Ilse gen Joaquin Gaunty Md"nagwner Ol„yYn"d ay*nrSr srflhawrs taalUh0 the loilwovv I eertlfy char in tm Perforrlhwwe Of are wars <br /> for wrllctl this parftaN is fug44 f SA0H nor tilwoYPwIllons SWO&Ot 99 WOWERS CONPFNSA?l0 V Laws of C IrorRlt OoNacte^°;tiff-S er s4h <br /> cvntrsGin9 a�9nar,�re aaltlMa the 1blavwlnp I xrlS'trio:in,M Asrs4r+ffars�r of ti'It.`orlr lar wriicv7 trus,aomrd Is�susd anal!elnpleypar.Iena;J�or•ct Io <br /> tav>gnr:>as CvrrP�hsaT�Iv Lass or Col+Yvr»!a <br /> TH AANT T CA"48 WORKING NNS IN ADV,ANCI: r-0111 ALL FSl*GL'IRED INSPECTIGMS <br /> T.t+e <br /> SEE SITE MAP I UNIT IV WORK PLAN DATED <br /> DCPARTMMY US!ON{-Y <br /> AppliCstMr,Amip iti;ay dam Issued Arp <br /> Gro+,t hupeetwn By Date Feral lrsspaaltsn gy_ _ _-- Door_ <br /> Oel1.2cper Inat»ctta+Hy UItIO T� <br /> COMMENTS!CONDITIONS - <br /> ACCOUNTING ONLY Alltd � <br /> PE C006$ FEE 114RO AMOUNT RVMryrD CHa:ck iJiL;C'p BY t7ATTe PFRs+ItT J SERVICE REWP-37 F INVOICE <br /> C J7 LICENSED CANT&ACTOR Nitro Sl(; Uc>?rrsl�s�wU1�bF.�ts coNrx*as�rIt7N DEc�.�t rIoN <br /> VNIT CV 6!'23!99/sign bkWMI <br /> 07/18/2U40 TUB' 31 26 ['IX/RX NO 57631 9002 <br />