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PAGE 03186 <br /> �i_'7 2004 16:25 91663$56'. CASCADEDRXLLING�- _ �• -- <br /> I,KAdLL:l'Lll�—L+tj 7 <br /> �10/�0/2004 14:27 VAX 91Gs79'L9 ] ux�-�� +k 4 t <br /> ll;>u?l San Joaquin County SITE <br /> ironmental Health]Department' , <br /> r CA 9�s202 MITIGATION <br /> East Weber.Avenue,3rd I'Inor,Stockton, <br /> y V <br /> - �J 468-3449 Fax: (209)468-3433 Web:www.sjgov.org/ehd UNIT 1 <br /> 4 ONMENT HEALTH well Pernnit Application <br /> PERM1TISEftVI�ESNRFUNDAF <br /> K i3 $LE PERMIT ExPIRES 7 <br /> VF W1 FROM DATE t$9UED 11callon Is made In compliance Wth San <br /> constnid Applieatlon is hereby made to San laaqula �`{OF nd thel5tandards of Sanldoaquln County E ionm ntsl Yltealpitl Dapartme>1tAaaassaM <br /> r <br /> Joaquin County pevelgAment TIt1e,Gt►ap! 1S ` 719 -�percel Z Z <br /> Cross5trea; t's � <br /> City <br /> Q <br /> WELL Location X12. l 1 <br /> PROPER 5G Clly I 1pu�0 ptlone _G 2S <br /> Sr, Addreasy'n�bW� --�L°.�, i4� G�3 —�10 <br /> oUmer -3 CCIty�C 6 c c�aZlI, i- klc#7 I 5 hone# <br /> G-87 Contractor C4 ID Addr3� 2D 5-qp4 Sat >�e Td _ PY�one#q i b"� ` <br /> �1302 S �r� Fcwc ress Lr6�b (wry�[uy_ �t)` <br /> Consultant I Sub Cntr_ _� , Tl If. Saetlon_ <br /> eja Coordinates:X <br /> fl4 <br /> Y Towhip i�.Range' <br /> WO RF <br /> RING CPT,QEOPROBE,I IYDROPUNCII,HAND-AUGER,OTliERh ©O E BORE IpDIAMETERse type b2tote) <br /> Eyll WELL 1■ I a PRE-d8URE GROUT <br /> []SOIL BORING7t <br /> J* 0 GROU SpECIFICAvoNs—_� <br /> *Other <br /> COMMENTS: <br /> ' N s CA � a Il <br /> INarer tATIM NPS CONS <br /> TYPE E Will. -- <br /> ONFORING OLLOW STEM DIA.OF BOREHOl_ t.? 0 MUL-1 IDLE CASING& Q MULTI L EL 'VCVVECASINGOTHER; ; <br /> EXTRACTION �R HAMMERIDRIVEN CASING THICKNESS�0 TYPr OF CASING: u STEEL >11_ - �AUGERS <br /> DEPTH OF GROUT SEAL 19 TREMI`E TYPE TO BE USED: �uGERS ]HOSE <br /> n VAPOR 11 Mur,ROTARY MOTE:}MAXIMUM FREE-FALL DEPTH 19 30') <br /> i <br /> U AIR SPARGE!OZONE 0 PUsm POINT(GP ar CPT)GROUT SEAL PUMPED: las No (NOTE <br /> 1 <br /> U SOIL BORING 11 HAND AUGER GROUT B1PEGWICATION3 <br /> a OTHER;_9 OTFIER�•��.. APPROx.130FZING DEPTH_S 1 a T. So��OLTED TRAFFIC BOX or p STOVE PIPE <br /> C ND UCTOR C SING PROPOSED I [f YES,1Wsyeclgoatians in comrneni section) <br /> II ,l. l <br /> CONiMENrS; <br /> NOTE: OFFS <br /> ITE BORINGS REQUIRE ACCESS AGREEMEINT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby oertlty that 1 have rePa this pllcatloD and that th6 work thrill be dolts In accordance with San Joaquin <br /> Gaurtty ordln ces,R is Rd Ula s,and all upplicatsie Califomis State I.�Iws. <br /> TltlalCampan�•I � "� � �� " " <br /> slgri0d10 <br /> Prink Name <br /> OF-PARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FlI I ADDRESS: � <br /> WORK PLAN DATED: S Z- D` 01 <br /> II <br /> 1 <br /> Date rssam f L D <br /> d ea <br /> Appricatlon Acoapted By <br /> Grout Inspection Ery_%a".1 . ;^-��`-1-— - Da1e Final lnspBCllon BY <br /> Destructlon Ins Ion 8 Dam li I <br /> COMMENTS I CONa1TIONS: <br /> ACCOUNTING,ONLY: AD# *ACRE Ct]DEB FEF INFO AM1+tOUNiT REN11 fTr t] CHECK# DATE PERMIT I SEFMCE REDUESTO INVOICE <br /> .� a� 06g0 !t i9vy SR# p 6 <br /> C-57— WC-WAzVEP— C-57 Letter of ALIthorixation to sign permit 'L:Encroachment doc— <br /> F19V 29•Q2 Obt <br /> 6122A'M <br /> I <br />