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Son ,Joaquin County <br /> Envit'onmental Health Depa>lmentNOV - 4 2005 SITE <br /> 304 East Weber Avenue,3rd Floor,Stocicton,CA 95202 MITIGATION <br /> (209)465-3449 Fax:(209)46&3433�Veb:%-%llv.sjgo MENT HEAT I HUNIT IV <br /> Well Permit Application PERMIT/SERVICES <br /> NONREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County for a pemrit to construct 80111"blettIll the vrak tleacrsuetl. This <br /> Joaquin)Cowlty OeveWpment Tale,Chapter 91115.3 and the Standards of San Joaquin app#.Deparr is nt. G1 compiiancs with San <br /> � County Ertvkonmm�ntal Health Depar'4aent. <br /> Assessors <br /> WELL L.ocaBon 2401 MacArthur Drive Crass StraetEasl Grant Line RdClty Tracv }Jp 95376 Parc6b# 213-070-50 <br /> PROPERTY <br /> Owner Leprino Foods Company Andreas 2401 MacArthur Drive CityTracv 95376 PouafeN (209)833-4266 <br /> C-67 Co hactaf TEGAddress 11350 Monier Park Place Rancho Cordsva 95742 706568 916 853-BOto <br /> Ciry_Flp Liti` Pha1a#( ) <br /> Consultant Sub Cmr_Q=j ons. Inc Add 8363 Centennial Pkwy,Ste 210.,Louisville,CO� plp1tpg (3031 fi65-4390 <br /> GIS CDordinatw,X TM 6 9 Y 417092ON Townehlp its Serb l Land Grant <br /> WORK TO BE PERFORMED: <br /> KNEW WELL/BORING (cPT,GEOP HYDROPUNCH,H4ND-AUGER OTHER") 0DESTRUCTION (Groosetype wow) <br /> 0SOIL BORING# - throu h - 0OVER-BORE. aAMETER <br /> 0 WELL 4 Q PRESSURE GROUT <br /> 1).0thar GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE P <br /> Q MomITORINO Q HOLLaN STEM D[4 OF HOLE 1 ' 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: <br /> a EXTRACTION Q AIR HAWAEFVDRIVEN CASING TN TYPE OF CASING: Q STEEL IIPVC Q OTHER <br /> Q VAPOR Q tVItEO ROTARY DEPTH OF GROU SEAL TREMIE TYPE TO BE U5E0: Q AUGERS Q HOSE <br /> a AIR SPARGE)OZONE &PUSHPOINT(GP orCPT)GROUTSEALP QYes QNo (NOTE:MAXIMUM FREE-FALL DEPTH IS 30') <br /> &SOILBOMNG 0HAND AUGER GROUTSPE ICATI <br /> Q OTHER: n OTHER APPROX. NG DE a BOLTED TRAFFIC BOX c r Q STOVE PIPE <br /> CONDU ORCASINGPR EDL_(If YES,Gat specifications In contmeMsection) <br /> COMMENTS: Geoprobe borings to ap rox 12 feet;to be bandoned immediatel <br /> NOTE: OFFSITE BORINGS REOU E ACCESS AGREEM T OR ENCROACHMENT PERMITS. <br /> 48 WORKING OURS NOTICE REQUIRED FOXINSPECTIONS, <br /> I hereby certify that 1 have prepared this pplication and that the work will in accordance with San Joaquin <br /> County Ordinances, Rules and Regula ons,andall applicable California Ss. J, <br /> Signed T�ae7Co an fty <br /> Part Nam pee CJ` <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,AD. ESS: <br /> WORK PLAN OATED: <br /> App§ication Accepted 6y Dote Issued Area <br /> Grout inspecfion BY Date Finan Inspection By Dare <br /> Destruction inspection&/ Date <br /> COMMENTS i CONDITIONS; <br /> ACCOUNTING ONLY: Alp# FAC# <br /> PE CODES FEE INFO AMWNT REMITTED CHECK# RECDBY DATE PERMIT I SERVICE REQUEST# INVOICE <br /> SR# <br /> C.-57_ WC--WAIVER— C-57 Letter of Authort2ation to sign permit_Encroachment doc_ <br /> =29.93.001 <br /> 6,,,0; <br />