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APPLICATION FOR WELLIPUMP PERMIT <br /> SAN JOAUUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION <br /> P.O. BOX 388,904 EAST WEBER AVENUE,STOCKTON,CA 95201980 <br /> (2091 4683420 <br /> NOW REFUNDABLE PERMIT EXPIRES 1 YEAR FRDM RATE ISSUED <br /> 1C.EpNIE M TTIpIkBIE1 <br /> APRIDATION IS HERE BY MADE TO THE BAN JOAQUIN COUNTY FOR A PERMIT TO CONSTRUCT ANOIOR INSTALL THE WORK DEM RFBEO.THIS A%'LICAMON 18 MADE IN COMMANCE WITH BAN <br /> JOAQUIN COUNTY DIMMOPMENT TIME.CHAPTER 94116.3 AND THE STANDARDS OF BAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES,ENWPoNMENTAL HEALTH DIVISION, <br /> Joe ADNEeeroe 374 Lincoln Center Cm Stockton PARCELSLEVAPIGN 097-41-29 <br /> Settling Dry Cleaning Defendants SDCDs* 1900 Powell St. <br /> OWNEA'BNAME /n nnnald T. R.ndch— TF0nw-FT-0rYc-Ra1nn A..... F—Ex,111u,P E`1 OLAnli-11497 RIONE ISt n-6S9-/.Snn <br /> CONTRACTOR AOOREBB ISCF PHONE <br /> 6100 Be astopol Rd. <br /> BUB CONTRACTOR WeFkR neilli a ...asUw�pnl lJC1VR7-177AR1 FIWNE0]0]-1491-1184 <br /> TYPE OF WELLRUMN ❑NEW WFII ❑H%ACEMEM WELL ❑MONIOMNO WELL I TN OTHER Pilot boring L2) <br /> ❑INBTAMATION ❑WELL SYSTEM REPAIR ❑....C.?F ECT REPAIR ❑VAPOR EXTRACTION WELL I J <br /> 13N-0 Alp. H.P. DEPLH MMPefi_FT. %MWATERLEVFL O <br /> IYFE OF%IM% <br /> OUT OF WFII ❑OFOINTBICK M. ❑ BOLI BONNO B <br /> ❑DESTRUCTION: <br /> IN D US CONIMTROWO VECIRCA O A <br /> ❑INDUSTRIAL QOI4N BOTToM OM,OF WELL EXCAVATION 16 inch DM.OFCGMUCTORCAMM 16 inch O <br /> 11 DOMERIC/PIl VATE 13 MM PACR/MZE TYPEOFCANNOISTEELANC Steel DIA.OF WELL CAMM 12 inch O <br /> ❑PUBLKrMUNKWN ❑ORRIN OEWNOFOROUTSM 0-30 Neat Cement SPECIFICATION cement-bentonite A <br /> ❑IMMATXIWAO ❑OTHER M.BFALINSTALLED BV di-ill— OPO.BRAND NAME E <br /> ❑.ONION. OMUTSEKRIM%D:®Yr 11. CONCRETEFEOESTMBYDNLLFAZYm QHo S <br /> AFINOX.01.11 140 feet LOCKINO CLEVER SOX/a10VE NK s <br /> T ,GMUS CONETRUCHONIMBWXO MV.O: MUD NOTARY X AIR MTMY AUGER CABLE OTHER <br /> 1 well and 2 borings <br /> I HEREBY CERTIFY THAT I HAVE%IEPARM THIS APFUCATON AND THAT THE WOW.WALL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY OMINA.ES.STATE LAWS,A.IpaES ANO <br /> nfOM.NT10NB OF THE BAN JOAWXI COUNTY. HOME OWNER OR MENVO AGENT'S SIGNATURE CERINIES THE MLLOWL:'I CERTIFY THAT IN THE PERFORMANCE OF THE WGIM FOR WHICH <br /> INS MWIT 18 ISSUED,I$HALL NOT EMKOY PENTONS SUBJECT TO WORMMAN'S COMPENSATION LAWS OF CALIFORNIA.'COWMCEOR'B HIW NO OR BU"OMMCT WO MONATUR CEVIFNS <br /> THE FOLLOWING: 'I CERTIFY THAT IN THE%RFONM.WCE OF THE WOW:FOR MUCH THIS PENAL IS ISSUED.I SHALL EMKOY MRMINS SUBJECT TO WORKMAN'S COMPENSATION LAWS OF <br /> CAUFONIIA.' THE APMCANT MUST CALL N HOURS IN ADVANCE FOR ALL BFOUWm INEFEC.NS AT LEVIN 404.23. COMISETE DRAWING AT LOWER AREA PROWDM. <br /> Site Project Manager <br /> pOT%AX ID—.Se..I Ea.H_ <br /> 1.NAMES OF VWVB OR MADE NEAREST TO 09 BOUNCING THE MOF`l Y. A. LOCATION OF MUSE SEWAGE gBPOBM SYSTEM OR NFILMSED <br /> Z.OUTLINE OF THE AORRrv.OIWNO DIMENMONS AND NORTH DIRECTION. EXPANSION OF$MADE NOMBM SYSTEMS. <br /> 3. DIMENSIONED GUILDS.AND LOCATION OF ALL EXI VINO AND IIOMSED S.LOCATION OF MUS WITHIN RADIUS OF ONE HUNDRED FIFTY V. <br /> STRUCTURES.INCLUDING COWAD AREt SUCH AS PATIOB,OR@WAYB.AHO WALKS. ON THE PROPERTY OR ADJOINING FIROPERTY. <br /> nn� <br /> pFylFuuwllwm AMP <br /> MW5 LVMD42 I'm I <br /> LVM F MW4 <br /> MW10 <br /> LvMDE, WUNa <br /> M B <br /> Mw <br /> ' WI M O <br /> ® Poemv Nnees MWZ M <br /> 'YMMCkaninE 1,11, < FLp <br /> Po:oe,%m: G <br /> L,pfJQ 1pcA{L� ay <br /> MWIO� <br /> B rilh MWII <br /> R MMPI' <br /> ''moi • D <br /> Chnu y <br /> ¢ Ga,Suxuo Dw-1 <br /> E <br /> MW5 �C AY�� <br /> PA`.' <br /> Bum Ovsluio. <br /> Ifamn:lYR•W <br /> I <br /> -e ne n e rs na <br /> mw- <br /> isent Decree Order Judgement and Referencedo Special Master, filea wiEn cne <br /> court on January-18-1996;�Secttiioon IV, Paragraph C DEPARTMENTusEoxlY <br /> APPWMbn Ma9/^I BI (M�/✓/ DM. � LT-�� Ar <br /> OreN lmpsllan By <br /> 0.1. %mP lmploWn BY D.I. <br /> Drincaan WP.^Ilan 9y DD. <br /> C....,,., 161Pnwf4JWo <Ayy , &UTt6S -t,S(,&a#Grl- IMAtD <br /> ACCOUN15NG OHM AID' IAC. <br /> PFCODEE III INFO DNT ROATTED CHECB'ICA.H ....WO BV DATE PENIIT/EERWCE RLOGEBUM <br /> T NUMBER HAMCE <br /> .2 - b C, Z <br />