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05 / 24 / 2006 14 : 36 707374r " 7 WOODWARD DRILL - ; CO PAGE 03 / 05 <br /> 05 / 23 /2U08 TUE 16 ; 59 M 0n02 / 004 <br /> FILF cnpv <br /> San Joaquin County <br /> Environmental Health Department SITE <br /> 304 East wvbcr A.vonue, 3rd Floor, Stockton, CA 9506 JUN 16 Ppl Vt1lgATION <br /> (,209) 468-3449 Fax (209) 468-3433 Web: wvvw4gov,0XWand _ UNI IV <br /> Well permit Application tr.s I „ (;HEA11L <br /> NON-REFUNQABLE PERMIT rxmt�3 7 YEAR FROM DATE ISSUBD L T Fi D `p •^, R T i'I �NT <br /> Appllcallon 19 hereby made to San Joaquin County for a permit to wmhuct and/or install tlra work denDMad. Thia application is M060 in compliance with San <br /> Joaquin County Cevolopment Title, Gwlor o-1715-3 andI the ataadands"of San Joaquin County EnWranmenral Hes15r Depadmerd, <br /> WELL Localloa `74(50 N El p&a ,rad Crom6keot& gpQemtNty Sa6.r -on xiP g5a10Aftaomm_°_pr 3r�O_�•� <br /> PROPF _ V�QfL� J �tlde7wner, 21 78@! A <br /> 7(I horyrmrt. �Zfp px9 <br /> C-57 Contractor oo gree e . Brix33! City o Vw <br /> a 7 { gao <br /> 70 <br /> O0n9ultant1Stib Cntr s r Addreao <br /> .. a.�l-� _.» fWitr5arl'�i�lldt Phonoro`ifG 74 zZ�j� <br /> raysCcodlnalaX l. 3f7 <br /> , Y 1 . <br /> TOmship <br /> 14 R e r��ri � <br /> �9 Section AO <br /> WORK TD BE PERFORMED: <br /> )(NEW WELL 1 CORING (OPT, GEOPROM HYPROPUNCH, HAND AVG< Rj 0TWPR� p DESTRUCTION (a am type beluM <br /> B SOIL BORING 0 n OVER-BORE DIAMETER_ <br /> ]I"INE BYfe rr /// /Z � !3 ONS p PRESSURE C+ROUT <br /> -�pQ'roOfDhr GROUT SPECIFIcA710N5. <br /> COMMENTS' <br /> TYPE OF WEf.L 1NSSq(�16N TYPE � EOIFICA <br /> )'MONMCRING (iOLLOWSTEM DIA OF BOREHOI Irl IIMULTIN4CASINGS QMUL71-LEVEL WELLOASIN(3DIA: Z-) nw <br /> 0 EXTRACTION a AIR HAMMEREPOE_N CASING THICmMS 5Ctt 40 TYPE OF CAGING: U STET )(PVC p OTHRi <br /> n VAPOR n MUD ROTARY DEPTH OF GROUT 4EM,_ TREMIE 1YPE TO BE USED: gUGERSry <br /> AIR SPARGE! OZ POSH p OVE <br /> p ONB U POINT NT (GP or CPT)GtROUTBEAL PUMPED: )(Yes n No (NOTE; MAXIMUM FREE. rgLL DEPTH is 309) <br /> 0BglLBORING III KANOAUGER GROUTSPECIPICATIONS <br /> -h OTHER: n OTHI;R APPROX. 90MO DEPTH O S BOLTED T'RAPFIC BOX ar g STOVE plpR <br /> r <br /> CONDUOIVR CASING PROPOS®...dq. (if YES, ost sped(caWra In comMant Madon <br /> cQMMeNts� .')D C O . ra ?D -)melt Sttl YO OVC J iA�aDl R albaL Sic I <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTIOE REQUIRED FOR INSPECTIONS. <br /> I hereby certify that I have proparad this application and that the work will be done la accordance with San Joaquin <br /> County O 'nances, Rules and Reg`ulapons, and all appncRble Collfomta State Laws, <br /> Signed x � - 1�J�9 a� TikOvmpany <br /> Print Nara C O IL.1!%!wl rs <br /> DEPARTMENT U§& ONLY I <br /> SITE MAP IN UNIT IV FILE. ADDRES6' 0� iU • lecie <br /> � ��" Y <br /> WORK PLAN DATED: -O <br /> Appit®SonAooepted By Dale lanoaq (O 2! 1p Area �� <br /> Grout Inspection By ate _ ,_rinal Inspection By . <br /> Dootwollon lnspeclion By Date <br /> COMMENTS I CQNDMONS• " <br /> [AE <br /> CCOUNTING ONLY; AID$ ... FACIE <br /> CODES FEE MPO AMOUNTREMrTTED cHcGKs RECD BY DAMPERMITISUFMar RMUEST751 3 44th 1611ro <br /> C-57 Wr =WAIVER,- <br /> 0"57 Letter of Authorizotion to sign permlt Encroachment do <br />