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GRr -, DRILLING 925 10302 p. 5 <br /> nar zs 05 01 , 24p <br /> San Joaquin <br /> Environmental HealthDepartine»t SITE <br /> ]O4FAst\fderAvenue,3rd Rovr 6mubmu CA 95202 MITIGATION <br /> (200)468'344VFax:(zov)408'34nvvcb: wwp'%JxvV.vx9/':l1u <br /> UNIT IV <br /> Well Permit Application <br /> FROM DATE ISSUED <br /> Application hi hereby made muu^Jo"no/nuvw.wto,"pv^v/,mconstruct^w^w.^moxthe work uen':0m00 This spplicationis,m,o^m*nnv/mmwwith San <br /> j'*ownCounty onmmnne,dnoo.Cno/ter 0-,11o.xand the Standard*m13xoJnv«u`nCounty c^w'=mrm^/Health Dcpa«alvm�mmoovn�� <br /> VVIEILI.Locauo, w- ' '' pI WW f'~-CIrn=o,octnv "_ ~r/v 9y1^�' F-1�1104(__�^^�____ <br /> pROPER/r�*.��� ���� __� �-'- -��-- Poov� - <br /> owner- --- -_----- <br /> n�rcm�mm a�" ���_ **����^ <br /> o"="ltam/Sub <br /> - "v__ ���� _ _wvrea��� Jt '��/=��� vwl <br /> ' <br /> msc=��� __ .v_ .m°=mn _na�� ____m�m_ <br /> �opuwn,.wxwo�uo�m.�n,��> DD£S?RWCTw�N v*v=��"vvw°> <br /> WORK TO r-PURFORMCID; <br /> ~`'- onv�pm�»p n/*�sron <br /> � ���- -----_ '- ---_- <br /> V;()Il Opncoovnronm�r <br /> Owsuo�__ �_________� �_-_� <br /> u'Om`°r� mRcx// apErIF/o^T/oN'L______ <br /> CuMmEm7n`­ _-------''' <br /> uMONITORING OHot LOW STEM o/A.opmmjc*OLF-Z-'?� OwoLnpuc��INGo DMucru'rvsL »F.LLc*SmcDIA' <br /> Ocx/nAunom Umu*AmmsR/oRwrm CASING r|nuxwro«___ ___ /vpForcwS/wn: UmrsEL orvC Oor*sR.______ <br /> OvAPnn Dwuv/�oTAnv DEPTH opoxourSI-Al �L_:±'�' -_Tncm/cl~prroOeu:ru. aAL*N-RS ly10*s <br /> pAll(w*aeL-Jozomc ki,ur,I i po/wrmp.,,pnG*ournou pom/'cn: 8ws 0N (NOTE,mAx|Mom FREE'FA LLPspTwl$3g^) <br /> m�u��oomwo ^�'xxwoAuouR GROUT SPECIFICATIONS_ <br /> ' � �,pnnxuomwwr��o*p '�� p���r�ornmpp/uaox °, uonw/ rn`c <br /> _ . <br /> mowoonrnpo^s/wnrnm`osso _ (if YES,xstspecifications wcmmnvote: m) <br /> comMsmrm: _------_--_ ------ <br /> NOTE: OFFSITE 13ORINGS REQUIRE ACCFSS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE ACQUIRED FOR INSPECTIONS. <br /> I hereby cortify that I have preparod this application and that the work will bo done in accordance with San Joaquin <br /> County Ordinances,Rules and Regulations,and all applicable Co/xtp,nia State Laws, <br /> monemx� -------_ �--___�_---�r/umC"".p"nv____ -- _-_ -------- -_ -___-- <br /> Print wa.""-- --- --_ _ '_ �__-___�---- �___� �____ —.Date_ <br /> DEPARTMENT USE ONLY <br /> s/TF-MAP IN UNIT IV FILE,ADDRESS:- <br /> WORK PLAN <br /> oonEoo:__m }nxpLAw oATco:______�� <br /> «nmx=o"o^cwmuuuy. ---___- __ _______ __ _,,'"'^."°�� __ � ___ ___x°a_ <br /> '--__cmue-DL,btructjon InspW.ion By <br /> / .� <br /> AlDtt <br /> ACCOLINt INC,ONLY: FACO <br /> EC <br /> tEC'D 6Y DATE <br /> FPE CODES FEEINFO AMOUNT REMITTED CHECK# PERMIT J St-PVICE REQUEST INVOICE <br /> C-57— WC-- -WAIVER-- C-57 Lettir of Authorization to sign permit—Encronchnnerit doc <br /> Fl ID 2�47-001 <br />