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01/28/2002 17.55 2094683433 FIFTH FLOOR PAGE 02 <br /> r �vV JL <br /> 1A - <br /> WELL PERMIT APPUCATION FORM SITE <br /> • <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES UNIT <br /> ATION ENVIRONMENTAL HEALTH n 00"(PH8490) UNIT 1V <br /> 384 E.Weber,Thirst Fluor, Stockton, CA.,95M <br /> 1 (209)488-3449 <br /> 400aw is he"wade 1Q sen imam C " •1+t%F aoheb+vd andrw X� toa woe»e d=C*00.-R4 spolOgion 4 nUft 0 a0110w+w Wft sm <br /> i0mm ow"9.1113.3 a v M ftpoms of sm Joao%Combwgwe M_salm aw�iom e� FGOM O <br /> UI'i:t1.Loeb '�� 0_ C++oss$rrat C�I.�eG�as3t�_ � ' � 1 7 5 <br /> Aftemes <br /> Iate pwro e► <br /> Off Conir�r S��D.ga 1 Cigr �S�r�rt�e73B�0.X.A++a+�141b� YL OD <br /> Cows�dtaat�SubCanaaemr llcti(n,..!�ntv�s�deeeea.j�l�Ts��Ks�j��Gb�u�i� L� �ane�►l�i�rlg3�c-�b3� <br /> Mum I an <br /> 1ri mw wuLI omme cc".aeOrMO®e,1iVC110PumL mAl pAuGm avium 9a�"babes) <br /> llaon.eaRwGs ° GROUT <br /> IMPALA-w� �.L �€ <br />�om"mme Noui.ow s� vra o�90R8FIQ�F7LTlP�c.�s+ s�p s U NO WaL cAmm ow. <br /> 0 wmv rm DA+R NAMMEMVMvl=li CAWNG- KXN= Wft of CANIS; 133t= CPVC 0 01WIM_ <br /> a VAPOR [IMWRUr uan O AUMM p NOSE <br /> a AM WARM p punt Pow WmY sm%L PIANP®- a vo ma (NOTE:MAXIMUM FREE.FAU DEPTH!S 30') <br /> a 80R em"G Q E+W AUGER GROUT ATgHs- <br /> A"POGt 9OftN%0EF'rH Q 9MTW 7RAFaiC BOX w p STOVE PIPE <br /> 1. oR cA�wtaPr�r t��na:oadaa>so�s aerox <br /> NOTE: OFFSITE BORINGS REQtARE ACCIESS OR ENCROACHMENT PERMITS, <br /> CALL THE UNT N 9WECTOR 48 WORKING HOURS X AUVAHCE FOR ALL RE12UM D 1NSPEC7'3t3NS. <br /> 1 hemby eortffy that 1 Lj;repw*dthm*WkWanandVWthvww will be done In scoardanae wdh San Joaquin <br /> tou"li an appt€=mw Cali wT"stake Lam:. <br /> l <br /> Smwd it <br /> pdm dar S&..4:60 : pale <br /> DEPARTMENT USE ONLY <br /> ISITC A1AP Ft UWrT IV FAQ Q <br /> WORK PLIeW DATED: �'+ <br />.*5mrm <br /> C'mm _bzdf Dot, <br /> a <br /> ACCOUNMONLY' Am <br /> PE toms Fm wo I810Ru T awnTm CIO=0 wag=sw DATE Jnr► lV[W RSTx KVG CE <br /> G-57 WCC WAZVER C,-97 Lettw 9f AtohorLmirrm to s%n pernw?_Ersaroechmmt doc— 9/27/40 <br /> 1 <br /> 1 <br />