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., 12/15/2004 17:25 2094683- <br /> FIFTH FLOOR 1 <br /> `J PAGE 02 <br /> 12/09/2004 15:11 4648130 ENVIRONNENTAL HFA PAGE 01 <br /> San Joaquin County <br /> Environmental Health Department SITE <br /> 304 Eas(Webar Avenue,3rd Float,Stockton,CA 95202 MITIGATION j <br /> (209)448-3449 Fax:(209)468-3433 Web:www,ejgov.orWo d UNIT IV <br /> Well Permit Application <br /> NON-REFUN ME PKRMR MIPIRW I YEAR FROM DATE ISSUED I <br /> APAIeAden Is hereby made to Ban Joaquin County far a paMYI M eorch d UAW k1*9 6*Ork daxdbmL TWO npPEcalian iS Made In emnpba with Son <br /> Jaaq,dn COw*,r Tile.Chapter 0.1113.3 and SI dards 60 Uin Dray 9Mtonme tal aah aparhnent <br /> WS�.I.Loratton S. Q.!"1Qi /S� f�ty `•" aT Pare_GQ ", <br /> PROPERTY <br /> Owns <br /> CLT CaIUamar IS 6 VillpKr""�drOas <br /> DenaOaardlsuh L`m�l•�+TT R AT was <br /> ... lTV71► o <br /> 615 OAerdlneles: �o Y .'r aLaMp / Rang secaaa�...—•— <br /> D ORM <br /> NEVIIN€LL IBORINGHYIXtOPUNCH.HANDAUGER,cMIP) DESTRUCn0N (pwosetypebo" <br /> RSL JAE-1 S �OVQi-BORE'. OIAMETFlZ_ <br /> 0 WELLA r 0 PRESSURE GROUT <br /> aIftw. �'f---�� GROU7aPECIFICATIONS <br /> COMMENTS' 7' `.�d>'°A ryar'r►•h'S �� - <br /> TVPEOEMLL r"MLLATION TYPE SJRUCTEOill Se OCATICNs <br /> 0 MONITORING 0 HOLLOW STEM 01A.OF 9OREHOLE, 0 MULTIPLE DASINGS 0 MULTA RAL WELL CASING DIA <br /> p f7MCrION QAIRHAMMERIDRIVEN CASINGTHICKNESS TYPEOFCASIM; WELL pPVC 007mm' <br /> 0 VAPOR a MUD ROTARY DEPTH OF GROUT SPAL TREMIr TYPETO BE USED; BAUGERB 13 HOSE <br /> BAIRSPARM Z W)JtJSNPOINT(GPorGPT)GROUTamPump= OYaa ONO (NOTE:MA)UMUMFREE•VALLDEPTH 18301) <br /> SOIL BCRIKS CHANDAUGER. =UTSPECIFIGATIONS <br /> 0 EgLOTHER _ APPROX.BORING DEPTH 0 BOLTED TRAFFIC BOX Or g STOVE PIPE <br /> CONOUOTOR CASING PROPOS— (K YES,fiat epemvweaons in oarnmem eeo5Oh) <br /> COMENT& <br /> NOTE: OFFSITE BORINGS REQUIRE ACCE&&AGREEMENT OR ENCROACHMENT PERMITS. <br /> 4s WORKING HOURS NOTICE REQUIRED FOR INSPECTION& <br /> 1 hereby cartHy th 1 have pre iered this application and tllatthe Work MH be dont4 ht aCCOrdwICe ufdh San JOEQuln � <br /> C it p i n s, as, n Atyu a TNi all applicable CaHronnfa State LAws• Jro <br /> rga TMacamParo LVAI�d l b <br /> Prila Name <br /> EP RTM NT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADORES : $ Jr i <br /> WORK PwN DAreD: Date Nauaa /�!$�b�-- � <br /> ppm Accapy y <br /> Grant Inp9edian 8yd g [Rtna_.���Final Inspeeawr By Data...��— <br /> 02sh rae rbaa CJate <br /> OOaaEBnI8/00NOR1O . <br /> ACCOUNTING ONLY: AIDe FACR <br /> tUd9DBY GATE pERMIT156RVICEVRgE4YEST• INVOICEPe CODea rar wo AMOUNS Tc 4ECK� I W SRS O <br /> a� ( ( ermiT Encroachment dor^ <br /> C-57 WC-WAIVER C-571.atter of AuthorlZUTian TO sign p <br /> &J2104.a2.dN <br /> amros <br />