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01/23/2003 09 44 2094683433 FIFTH FLOOR PAGE 02 <br /> • Jan 23 03 133 Dia Iran Env- Inc 816 's 2172 s'•2 <br /> ... 'ter cuo7 rie .1I 2dR--j3433 Fia'rw r Opp <br /> f <br /> Fc,!��W -- WELL PERMIT APPLICATION FORM SITE <br /> J q N ; 6 2003 SAN JOAQUIN COUNTY MITIGATION <br /> ENVIRONMENTAL HEALTH DEPARTMENT(EHD) UNIT IV <br /> EN'AR,jNM;:N7 HFALTH 304 E Weber, Third Fioar, Stockton,CA.,95202 — — <br /> PE W.'TiEfl4iCF5 (209) 468.34-09 /'1 <br /> I�RFFUN+]II3f_E P-V-N(T pxpl$tEs l YFAR FROM O•Tr=issus7 �f <br /> AP9."""7"Or S here'Jy made tO Sa'+tnagvin Coa,ry far s r A to zonTz'f3 anxcr"riviii me work delcAbeE Thls epaLcat wi rc made-n camp,an�wm Sin <br /> J+ugwrr.Lounly Devet=mCnt 1!JIe ChaiNce 9 1115 3".he SrarEam s of San.ioaguih Counry Env,mrtmertt(sr tieaxir OeparirvW <br /> A--LL -l- /Lssr�siils <br /> Li Loc-uon I0 W ...,L me-, L Clava S'rev t, i�`t y5-if4�)'r <br /> PstOr_rarr vwnee e <br /> Aeerss. e'C¢AeAvm(zs- <br /> �5`Can acar��` 7l�ti r cn�G eC,HJ i� Lp rF 6%q mon C r rlst <br /> Concunan 1 Y� I ddressra0l .14a T .jy�/ l_4ia,Phcney { <br /> G'S C=f-.n2te3 % <br /> - Y Tow+ahlp R1n9C �Sca,o <br /> 1Mrp K T Cfl RMEU i <br /> r ErV�'rF.:r BORING P EOPI:ZaaE,HYL-FtiPU�,.0 } HAND-AL 0711ER-7 q OESTRUCT(ON{choose type evowl <br /> Q SOIL 60RINC s <br /> p WELL t CvFa.7�RE <br /> ��" Grot r Spenlr�t ons fl PiReSSURE GROtlT <br /> COi41�1�RTS <br /> r x� <br /> 1'1'pE OF-IF-L—L IQ�TALLATt_ON T(pe Cux�TAVC�pN SPEGif CA'►10HS `/610" <br /> Q V0\"T0R hti Q-O(A OW STEM CIA OF 80RPnOL�,MLILTIpLE CASINOS?p L111LTI1 iVEL-10 wE1.L CA3 hG CIA t%4%-t <br /> Q ExTP,ZlriC f CA Ft HAMMEAIDRIVEN G'<5t\a Tt-m:e-%jESS-4t L- TY?EOPCAZI7 G 0 STIM Q F'vt U CIT"icr, K4-0- <br /> L V i]R Q vie po-ARS Ur"IM OF GROUT$;-A C- TRF=%,IE TYPE TO 3E L5FO Q A:1GER5 ,�{I$ <br /> AT 5;AAG2 r t7zuneXPUS4 POINT-G.r 7 WC -Pu--C-O �5 ee ©No NOTE :'kl AXPAUM FREE-FALL DEPT){ I . <br /> aOR NG D HA\0 AUGER GROUT sPf-C'F'CATt0N$ Hi+.Oil 64±!± <br /> Q OTHga _ n C'-i:R_ Aip4Ox BCR NG DEPTk+ n 30iT:f?TFLSr'F7G BOX qr p STQVE p"P5 <br /> CGvDvCTOR A5"�+G PFiD.'OSEOT iS.G t IrYES 4sr scot rurn�s heY� <br /> cCtAMEhf� <br /> NOTE OFFSITE 60RINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS <br /> CALL THE UNIT N INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL RFC<UIREO INSPCCTTO.14S <br /> I hereby certify that f ave prepared 1hl's apR[ication and that the work will be dons In accordance with San Joaquin <br /> )C5:9 <br /> �uene txy Ordin c les and Rewgulat �!s andal applrearblecCa-thfam <br /> ra State Laws <br /> 40±-F540±- <br /> pr-it <br /> r,t vase �W � r k(KdL�i/y�rl <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS 12,10 � [ �% <br /> WORK PLAN DATED 02- <br /> A.00 <br /> LA:0n"or AL`ce,7'ea By bah:1MV94 1�Z3 'O� •�� <br /> Grac,l re',SwO.ran R� Ctt�_ ,_.�.ENf tn..pei:tpn By03to <br /> DeWA;'-an rrsocctwr=Ely Uate <br /> COMMENTS 1 CONDITIONS <br /> ACCOUNTING ONLT ucir -- <br /> PECOCE5 FEE INFO AnatTtJraTREMYTED CHECK it RECO 0r DATE PCRwTt*ERYrc[R=QHlsTt ttiV4ice <br /> C-57-1[ WC •WAIVE2, C-57 Leiter of AuThorizetlon to sign perm t�Eft dam 8/29/02 <br />