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`01/21/2005 10: 47 . . 91'•67867891 ENGEO INCORPORATED PAGE 03/04 <br /> 01/21/2005 FRI 1C1::10 FAY D DD8 <br /> I <br /> 01/21/2005 N9: :!G 9167867391 BNGL•u IWC:IJ'r.'F'ClF!ATED FY1iaE U3/04 , <br /> San Joaquin County SITE <br /> :Environmental Health Department <br /> 04 8aat�Vabar Avenue,3rd F1C a,4tocktCa CA 95202 M ITIGATIO N <br /> (209)456-3449 Fax: (209)469-3833Wob:W%vn,.ejgov.cVehd UNIT IV <br /> Well Permit Application <br /> NoN•REFU DAELEPaRMITEXPIRMI YFAn FROM GATE ISSUED - <br /> AppaAttion o iewhymode m':SrC Jnsmu[n gourAykr a xrnt is ennatru*I®ndlnrinataD ihP work de"IbUd Thle npolkaUen ns made in ccmpllane¢wl!fi Sur. <br /> J¢agVln rinunly DenlaPTenl T1! rCFepler 9.lNiA and lho&landerds aiSan Joaquin County trNtf¢hmBrllai Heallh'7533rtenLA"'sme� 8 a 0—If <br /> lSa-0,.E.LPP IfRoO cmaeslmet xry l/k(fIRDP z,� Pwa¢Itl <br /> WELL L60".. - 5330 <br /> - <br /> PROPERTYLn.ro 6---k fo e,6,( 2NS Lill mc 9 <br /> Owno,X Set-� C3i`.Adtlrers <br /> arcarnnaor a�"��n" <br /> `�� OAudrrae too' <br /> 'IT ©ry, 71PM/LaNr�QPhaneA 4/ �7�-V/ei� <br /> C¢nauRantl BvE OMr� --aGtlless.Ajf�ffin�ttet A*Ily a;rfe_LdaM��—.-Phonek l� <br /> ,TrnrMgYIP Ron9n 3eclan <br /> Ola Oeorabletna:%���'�_�T` - <br /> I <br /> NrOeKTO ea PBeentlerml <br /> GW W�LLi EIORTN I FT ,P a K*'DROPUNCN,HANC.tivaGR,QYHER'7 pDE3TRUCTION (choose Lyp9 Bel¢wl <br /> IL SO%OFVN N - QOVER•BORE. bIAMFTErty, <br /> qwO 0 PRESSURE ORCUT <br /> 'tI WELLM --�- GROUT SFECIFCATIONB <br /> COMIUENT'8'. <br /> I <br /> er/ pF WELL IMk��L,LATIOei nPEIS�FFTION$P CIF, C�TIONS <br /> O <br /> MONITORING pE-iFSL'.04v,EiEM OLi OF aLM <br /> OROLEE GAE <br /> ,� pMULTIPI; tN08 DMULT(LEVBL WF,LLDA8ING DW: <br /> p EhTRAOTION pIAIR HANMEWORNEN 0AWN3 THICKNESS_&A TYWE OF OASINQl D STEEL 0 FXd OTHCR: - <br /> r3 vAPOR I}ILMib ROTAaY DEPTH OF GROUT$EAL_°.Tb <br /> TREMIETYPE T78Eum=a CAUGERS JrHOOR J <br /> „ a AIRSPAROE/020NE :010 HPOINT(GPnrGPT;^�ROl7CSF—ALPUNP5O: pYa��a// DyyNo (CNQ�TEe�M MUMFRGE•F'ALLDEPTH Is3D') <br /> $jr101t,PORING UMANU AUGER OROUr SPECIFIOATIONS_j�egl.: �h <br /> POTHER• ni0"HER ' ACPRO"RING DEPTH O eOLTIO:RAFfIC 60K or Dtl'OVEPIPE i <br /> ' fA'EB.Nt epaldhmeorid In menseclen) <br /> -y., � �� LP ogcu� INo PROP�� cs�..�-r..t mor. <br /> i <br /> r C0IAMENTS�. ..," /1 .moo <br /> I <br /> NOTE-. OFFSTl1E'® RINGS REQU E ACCESS AGREEMENT OR ENCROACHMENT PERMITS. { <br /> 46 wjN,4"OUR&NOTICE REQUIRED FOR INSPECTIONS, <br /> I hereby Cortlflr that 1 have prRepared this application <br /> and that the worlr will�done in accordance with $an JOaquln <br /> I <br /> County OroUnances,I$uWa and Rsgulatiock and all applicable Cs1101'Ila State Laws. 1 <br /> aleneax ^'T•.����j� 1 ;.'ix rlllMwmpernnmr Pf,�'A/Cr�� <br /> Pent Na ��2P9 CCl ele�d0/e.0 <br /> - DEPART NT USE ONLY <br /> 3178 MAP IN UNIT IViFtiLE, D 26:1� <br /> WORK PLAN DATED" !/ �� <br /> I <br /> Appllcadan Aceoptotl Ey Date IdaUad��2c/ <br /> Gtnul Inta+Bad¢n!y f h:'. Dow Fn¢i Ilrxnenian 3y -D:.Le j <br /> aMtngwen Inaperllon BY Ir D2:a <br /> COMM6NrarcONDITION�: <br /> AGOOUNTIN00NLY: <br /> AWN fAck <br /> Pi CODES Fee INFO aMOIINT REMriTaD CHECNC RECTO BY DATE NelnrlrrrsERVlog 1111WIFT f INVOICE <br /> I <br /> C-59 Letter of a Lthari24Tieh to sign peemlf,_Eccr=hment doc— <br /> eHb yc.tdaa I <br /> raved. ' <br /> ,li:1% 005 FRI 09:45 rT.T Ft% Nn 7,721 1?!D0.3 <br />