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-CASCADEDiRILLINGa PAGE e2/e2 <br /> II <br /> 1 f 2312004 _17:31 91663855.17 <br /> U95-5ACRA ()-UU <br /> '� T <br /> -- w _ 91&8792 <br /> 'rii23r2no4 iB:lA rA7t <br /> Sannen county <br /> Enyilrommlentat Health pepArtmlen# ' MITiGAT�ON (( )) <br /> 304 East Weber Avenue,3Td boat,Stockton,CA 95202 9 iff <br /> A�68-3433 Web:www.sjgay.org/ghd �� NOV 2y�ILf� 2� <br /> (209}4f$-3449 Fes•(2Q9}Well Permit ApplicationIlk YEAR FROV <br /> NowpEFUNDABLE AF tMIT EXPIRES' R 'TE#tS5UEp1 <br /> DA <br /> t:nthe VMI visonmeniai Health Depa�trnent, <br /> ab made to San Joaquin Gounty turn permit to ndards of San loaquaini t;ounty r described. This alth De art ismade Sesso spllancn with n <br /> Joaquin C is ty I Y i� zl ape <br /> Chaplet 9-1915.3 and tits 6Y ', <br /> Joaquin County pnvelepment TIt1o, P <br /> •���s; � Crass Strest�.21II { <br /> WEt-L Location f <br /> �_zlp <br /> Phone# `�a ! I <br /> PROPER{Y,,,� f� �j (os ��City <br /> OrmFr„�.�-� � Addr sa �c�t—� �A �O�! <br /> ' M Adflress��o .17i'q�c- <br /> C-s7 Contractor �L Phone#9l b-G m-2.e `I <br /> all, ddress`.LtRD „�+ tC ity '' <br /> consultant I Suo Cntr UR� t nn` I Section <br /> Ta+rmahfp Rangc <br /> t3tS CvordtnaMM X <br /> f7 7 R EG: i _ <br /> Q"EW WELL I BORING (CPT,GEOPROBE,HYDROPUNCH,HAND-AUC;eR,OTHER1 1 Q�BORE. DIAM(ETER typa� <br /> n SOIL BORING# `� -PRESSURE GROUT <br /> tgNVELI # I GROUT SPECIFICATIONS_--.- <br /> 'Other 1 ` / 11 1 <br /> COMMENTS: a � <br /> W 1k d Y\ �. 1r\� V�•�/ 3 <br /> ,.�unTotfenAwsPEGIFICATI0�13. <br /> dF YUE IMSTAt L-J�T3�t nce +�� MULTIPLE CASINGS n MULTI-LEVEL WELL CASING DIA: <br /> tUMONiTORING VOLLOW STEM 01A,OF SORENDLB51 <br /> EXTRACTION Q AIR WAMMERIDRiVEN CASING THICKNESS-n--k 10 T(PH OR U OTHER' <br /> MEI TYPtw TTO aE USED:NG: 0 STEEL VC` VSC3) <br /> t7 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEA t^��- <br /> 0 AIR SPAROE f OZONE 11 PUSH POINT(GP or CPT)GROUT SEAL PUMPED; 1�'Yes a O (NOTI�:MAXIMUM FREE-FALL PEP <br /> p SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONSgOL7ED TRAFFIC BOX or Q STOVF_-PIAS <br /> (I OTHFR:�, o OTHE APPROX.BORING Pi=P7H ,;�d <br /> CONDUC OR CASING PROPOSEI] ?. , �} (It YES,rut specs leallona In commont secilon) <br /> II j <br /> COMMENTS: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby cerci that I have repay thi application and that the work will be done In aCcordance with San Joaquin <br /> County aJrdi rices,Rule and gu ons,and all appllCable Callfornia State hLaws. <br /> TitIFlCnrnpary <br /> Signed x <br /> Print Nam is' Date <br /> DEPARTMENT USE, ONl-Y } <br /> ADDRESS- t <br /> SITE MAP IN UNIT IV FILE, ' <br /> WORK PLAN DATED: Z <br /> ApW1Catlon Aceeptecl By Date Issued ( Z-`� O Are <br /> Grout Impaction By Dalo Final inspocflon By d �{� w.,_ri�-, bete 2 <br /> Destruction Inspection By Date I } <br /> COMMENTS I CONP)rnoNS: !� <br /> ACCnL <br /> AIDtk II' <br /> FAC# i} <br /> PE CAIIAt?IJNT REMITTED CR ECK 9 RErn BY DATE P1 HfT I SERViGE REQt1ES F INVOICE <br /> oa�fa� � It ° SR# `� �( <br /> c-sr we -waruE <br /> P— ._ C-57 Letter of Auti�orization to sign errrtit h rKT.00chment dcc1 —# <br /> 6l12l2 'OZ-00I q <br /> F <br /> n i � <br /> 3� F <br />