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i;,Af • 6• 2001 I 2E P�,f <br /> Wrf.4Ut3.J/ i.4J(73 p t <br /> , t Envirol"T" al 832 5152 <br /> S. X10 <br /> WELL PERMIT APPLICATION FORM <br /> SAN JOAQUIN COUNTY SITE <br /> ENVIRONMENTAL HEALTH DEd'ARTMlrNT{EfiD� MITIGATION <br /> 64 E- Webell Third Floor, Stockton, CA., 95202 UNIT'IV <br /> (209y 468,3449 <br /> bYm�da to Sen Jo rlM',MibFtftYSA ROM F) <br /> Appllca�fon t4 barep i <br /> ���n Caun(yt?esne Casnh'1Fx a perms!to curutnicf anE3lor fnolAlr,ltawak <br /> IaPrrcextt Tate;Ctlaptgr&l ti5.3 and rfm 8larrderda od San J �° � Thee OPOCailon IE"C;e br co, [Vj a with <br /> Rr 0"�Caunry F!ititrnn,nonla7 Health San <br /> WELL L.ocaGvtr � �, �� � •.�I r �_�_��` City �/Z.A O�anment. <br /> PROPERTY C-0 X � Cny- <br /> --- <br /> OwnW a�F Aedresa7786.A.Tv-c,Lv,4 uF- yTwpuw Nar'zi 'y e <br /> G-EIYContradar l� - ---- p ph of <br /> Cana4ftid I ut>•Cnlr 5 R 6 HT yI vAddrom <br /> ,�, _ C1ry zry L �„oo <br /> GIS Coeranaeos -31 <br /> lltt R T Hmtigd ���SoOon <br /> NEIN WEkLI BOIiINCa (CPT.GEOPROOE,"MROPUNCH,HAND-Al1GfvR,OV"ER•a 4�4�4 <br /> �sN4E BORING - Q787RUCTjTd Ioaea type as,ew) <br /> OVER-801i 0lj4kME-TEEA <br /> 'OHIar E-.� lC. P0L PgD G� CaolE83URE GROUT `--— <br /> NT3: -WECIFICATiONS <br /> YYHLI INt3T <br /> 11 MONITORING Sesta€ ego o�-�� PCR WOO*PLA-1A-1-b .7i4PfiP`?AVt1>C'e,4 <br /> DIA.CULTIPLE CASWo!3 f1 MULTt-LEVEE. Wp:LL CASING OIA: <br /> 0 F_nRACTION p AIR t'IAMMERf011 CASING THIly <br /> )<VAPOR �]MUD ROTARY TYP[tat=CASING: 11 STEEL, >I WC �TNFR= J�)C4CdilJ <br /> DEPTH OF GROUT SFS <br /> ^ AIR <br /> SPAT'r OZOI a A175H PAIN] (GF CPT)ORO(1T SEAL PITidFCp: yg® rREMIE TYNE 7Q SE USEO: V AUGERS p HOSE <br /> kill a$OIL ROBING XHANDAUGER Gil$PECIF?CATkONS_ Qj tdo (8 43 : MAXIMU FRER-FAl..t..DEPTH IS 3I;B'y <br /> Q t7tf+�R: -r Tb <br /> ('THE!-- APPRO-X 13GRING DEPTH_ l----- �1 941 TEp TRAFFIC$p7{ Or �STgVE 17t?E <br /> (i <br /> CONDUCTOR CA51N(i PRpt�OSED � l ES. e Ilse s ��ff [tong rlr r,� N <br /> Corire:, <br /> NOTE: Ofs>`SITE�80S RE€:UIR CCE55 AGREENBENT R ENCROACH ENT PlERM . <br /> 48 VVORMNG 14OURS NOTICE REQUIRED FOR INSPECT&ON& <br /> U �Y r ►tlzakl[taus Anel► rod t711a al*llcat'an a"d that thO ill will be done 4n m=cIrdarrtce <br /> Ctwnty Qrdlner ,{� R laltica�,Bltd all&PPItill CMUIDMI&S�Law$, wiEli Sew JeaQtrrill <br /> $Iened x Dana'�1llf:_ �i7gf,y�pi-- <br /> TltletCom <br /> li Nettle_- �I�( . .P. I-q _ <br /> taEPA T BdT LUSS Nlll y <br /> SJTE MAP IN UNrr IV FILE,A[,ORFS& <br /> '6t1►ORK PLAIN DATED' I 1—}J Q <br /> goon Adcuplr 8y <br /> G,Qvt I <br /> 4rgyt�eCCgA ey ,.,,bsLa lseued��_ to —D A/na <br /> 28ElA+10" ev e-— — _�Finel"Opoesbn®y- Dain <br /> l�at4 <br /> Cd1V41RENT7!l t�DIMDIT1O1I8: <br /> ACCOL►NT1Ma ONLtl: AID# <br /> FACS <br /> PE CODES PSE I'll AMOUNTRLWITTEA CHI! d RIEC'sy SP Dl6Tt? <br /> R�Rtatrr J wil REQUEST$ IMVQICE <br /> CWC -WAS C_�7 Le#ter�of Avt�foriaatf to 5" <br /> -57 t o sigft Encroachment doc .tJ 9130/02 <br />