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. Ie <br /> Ji <br /> ORNEC 2 2 2009 SAN JOAQUIN COUNTY <br /> ` ' NVIRONMENTAL HEALTH,DEPARTMENT SITE <br /> WENTHEALT 00 East Main Street,Stockton,CA 95202-3029 MITIGATION <br /> MITISE"Qne:(209)1468-3454 Fax:(209)468-3433 Web::www;sl oy.org/phd UNIT IV <br /> WELL PERMIT APPLICATION FILE COPY <br /> 1 <br /> I NON-RF�EUNDA9LE PERMIT EXPIRES 1)(EARL'FROM DATE ISSUED <br /> _ Application Is hereby meds to Sen Joaquin-County for a WrM toconstructantllar Install the work dwAbod. This SppNratbn is made In compliance with San <br /> j Joaquin County Development TNS,chapter 9-1116.3 and the Standards of San Joaquln'County Environments!Health Department. <br /> Assessor's. . <br /> Well eLocation 2535$ N.} mes skeet Fi. �St I%N1AVl ISA da/ciry <br /> OYwnrI*-A5 �7e 7t 'wdreae.R13 Loa fkot•e5 Lw.+.City zP.�_PJIoneSzQL--4,�--#00 <br /> C-67 Contractor Won &Jla b illi Address •• C <br /> 1 ' /. kY—.__._. P Clerk 7/0o29Ptrme <br /> Con ultantl8ub Cntr 651Z! <br /> 'Y ^'��—'T ` - 11d7, Pfgr1�7�0'!,� .'�rr`lOaEt <br /> pddrass�/• A! <br /> GISCoorcitrud s:X 'S8•:ZIO�'aelb ownahip Range.. Section <br /> WORK TO BE PERFORMED: <br /> IN NEW WELLIBORMIO(CPTOIL BORING# ,GEOPROBE,HYDROPUNCH,.HANDwAUGER.OTHER-) <br /> [3 (CHOOSE TYPE BEL011) <br /> I ®❑SWELL* 'SV . — V T ❑OVER-BORE-DIAMETER.. <br /> i ❑*OTHER - - ❑PRESSURE GROUT. <br /> GROUT SPECIFICATIONS. <br /> '❑EXPLOSIVESDETONATING CARD <br /> COMMENTS: <br /> TYPE OF WELL. INSTALLATION TYPE .1•,0� ( ON BPE <br /> ❑MONITORING ❑HOLLOW STEM. :p1A.OF t101iEt1DI.E ' i i13 NIMTRLE CASINGS 13 MULTI-I.EVEL�y WELL CASING DIA: �/f�, <br /> EXTRACTION 13 AIR HAMMERIDRNEN CASING THICKNESS yjl�7yPeoF CASING:ta SrEEL [t OTHER (W� <br /> f i0 VAPOR [3 MUD ROTARY DIEMOF GROIJr 9EAL �� - TREMIE TYPE TO BE USED ].AUGERS M HOSE +" 1� <br /> 1 ❑AIR SPARGEOZONE 13 PUSH POINT(GP OR CPT)_GROUT I <br /> SEAL PUMPED:O Yee A No(NOTE:MAXIMUM FREE-FALL DEPTH IS_30.) `� 1 <br /> +I <br /> [3 SOIL BORING MI HAND AUGER :GROUTSPEGFICATIONS <br /> I _ 13 OTHER EI OTHER:... APPROX.BORING DEP13rH 'S �; BOLTED TRAFFIC BOX OR [3q STOVE PIPE L' <br /> CONDUOTORdAWNGPROPDBFD (axle.lk(eDedfiCMlauki.mmweuW?nI'- .: <br /> COMMENTS: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS'AGREEMENT OR ENCROACHMENT PERMI $_. X <br /> 4S RKIN(i N URS N RE UIRED FOR'INSP TIONS "'" -- / ,,, <br /> 1 hereby certify ha Pepe 8:8131011ee1110n andil6k the work will be done i accordance with San Joequin Courdy Ordlnrxas,Rubs and <br /> °, l.S <br /> Regulationan it b Ie Lowe. - <br /> i <br /> Signed Twacompam tFYf /Ca9iSS7/ �� +fl <br /> Print Noma *' Ci iS' Dg1B' 17— /.l1c/- - <br /> DEPARTMENT flee–0— <br /> f SITE MAP IN UNIT IV FILE,ADDRESS: a y <br /> WORKPLANDATED: JURE 25, 2009 .5pp-/-pm(.f�tp�- 1( �A0q N .2 <br /> APPLICATION ACCEPTED BY Ui e.+n r:a M e .n r-1-n 1 i -DATE ISSUED../2.23-!),9 .AREA��,� <br /> GROUT INSPECTION BY„Q7jy�jla10 r•60 nO.Oa-l�N FINALINSPECTION BY Vr/i"f0r;a.W17 a Car fuer„ DATE]-/g-/0 <br /> I DESTRUCTION INSPECTION BY - 0A7E " Q <br /> -COMMENTS/CONDITIONS: Sri.3+a l t&f.O n 6-f- 5 i I ` r- -59M.4" I S V 1. rov $ ,-q <br /> . <br /> ACCOUNTING ONLY: AID p- - FACW' <br /> IE CODES I FEE INFO AMT REMnTED CHECKS RECV'D Bi DATE PERMMISERVICEIF - INVOICE <br /> 3505. 89.otL 84. do °2150 m 1/-2 -.23 SR#o059dz$ <br /> -CS7 WC-_ WAfVER .;CST LETTER F :.: TIONTOSI1 M(T ;.- E '.AEh9.lENTDOC <br /> EHD 2"1 10/2699 <br /> WELL PERMIT APP <br />