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09/06/2000 WED 12:29 FAX 916 777 4101 V N DRILLING INC Q001/001 <br /> 03/06/2000 09:52 209463 - FIFTH FLOOR • PAGE 02 <br /> 99/93/2000 15:d7 2094GG3433 FIFTH FLOOR PAC 02 <br /> WELL PERMIT APPLICATION FORM ��Z ITE <br /> �111TIGATIgty <br /> SAN JOA4UIN COUNTY PUBLIC HEALTH SEN�k�IV <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD <br /> :304r-.Weber,Third Floor, Stockton, CA., 52J <br /> (269) 468-3449 <br /> NON+REFUNDABL-PERMIT E%?cRFa 1 YEAR FROM OAT-e ISGLIF� w` <br /> wlth <br /> ApallcaYon Is hereby mad.to Z,,n Joaquin County tar a Remit to ramcima,andlor install Ina want de scribed. This p °n is omdiar <br /> made.n rr_ $yi <br /> Jaagain County Ddveteoment T id9.Chapter g-t 1 t 5.9 and me S4ndads of San Jaaquln County Film neanh Services.EnvUonmental Ase,assarssoe.Ohlsisn, <br /> s <br /> WELL Leeatlon <br /> 2401 MacAurthur Dr crass Scout city Tracy,cA zp 95376 Parcelm <br /> PRoP°Rrr Ovmer Le9r ino Foods _ Address 2401 MacAUrthur DTCltyTracv CA_ZI0953.Z�—Phrn-;'ZO 233-4743 <br /> C-57 ConcaearV6W' Dri1J-int? Mdrest100 5th Street City L9 let on Zd56+1 L�cp12n904�?han�. 16' 777=4100 <br /> Gonsultantlsua ceafrsaeer HSI GenTrans 4dres9101 Harlan St.s'Ca•,tY2 t0 WecteviLsia*PhonoOq-426-7501 <br /> Oi5 Coordlnstes:k <br /> y TcrrnShlO Ranqe Sectlon <br /> ARK 70 eE P RFORMED' <br /> ESTRUaTION(ehocse ty9e tr6Nr) <br /> 11 NEW WELL!BORING(CPT,GEOPRo66,HYOROPUNCH.:iANO•AUGF�R,OTNER') U pVER.00RE <br /> Q SOIL BORING G &PRESSURE GROUT <br /> Q WELL C GROUT SPECIFICATION <br /> COMMENTS: W �. <br /> TYPE OF WFt.L WSTALLATIQ11 r E cON t1G1'ION SPECIFtCAT10 <br /> Q MONITORING <br /> HOLLOW STEM CIA.OF 9OREHOLe.B-1TtCh MULTIPLE G151NG5?❑YE5 q NO wE',L CASLvG CIA��i nch <br /> QtiXRACTION QAJR HPoMMERIDRIVEN CASING TFIiCKNESS SCIled. R;1'PEor CA51NG:"Q STEEL 70 PVC OOTHEq: <br /> QVAPOR aMUO ROTARY DEPTN OF GROUT SEAL2 Et- 7REMIETYPETOEEU9E0: IlAUCFRS' QHOSE <br /> Q AIR SPARGE Q PUSH POINT GROUT SEAL PUMPED: 0 Yes 8 No '(NOTE: h1AXIMUM FREE-FALL DEPTH 15 30') <br /> Q SOIL BORING D OHANOTHER <br /> AVGER <br /> GROUT SPe.,FICATIONPort land T e 11 <br /> Q OTHER:_ OOTHER APPRCX BORING D5P'TH 31__Feat OBOLTcO YPAFFIC BOR Or pSTOVE PIPE <br /> CONDUOTOR CASING PROPOSE02NOne (if YES,list spdcinaaacns hera): <br /> cOMMENTS <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMIT <br /> I hereby certify that 1 hQYe prepared this application and that the work will be done in scoordarlce with San Joaquin <br /> County Ordinances,State Laws,and Rules and Regulations of the San Jaaquln County. <br /> " GALL THE yUNIT I l INSPECTOR 49 WORKING HRS IN ADVANCE FOR ALL.REQUIRED INSPECTIONS <br /> ! l t111dlCampany- 7' r• <br /> Signed z '. I <br /> Print Nam Oht=rLf L- 'tj <br /> SITE MAP IN UNIT IV FILE ADDRESS MORK PLAN DATED <br /> DE AR ENT USB ONLY �� <br /> Oal,-I UE4 C1 6 D <br /> Appllgticn AC4CDted BY - t.-_ FInal Inspection By ala rt I I <br /> Grout Inspacson ey_I��^^^ — Dai <br /> Destruction tnapection By Da:e <br /> COMMENTS rCONDITIONS; <br /> ACCOUNTINGONLY! AIOE <br /> PECCOES FEEINFO AMOUNT REMrITEO CHECKti RECO 9y DATE PERMIT l SERVICE REQUESTi INVOICE <br /> a�io�, baa 1 ao ooa3 <br /> C-57_ WC/WAIVER C-57 Letter of Autharizaficn to sign Per It_Encroachment doc_ 7/17/00 <br /> 09/06/2000 WED 09:50 ITS/RS NU 60391 Z002 <br />