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JAN-30-1996 14:42 FROM ENVIRONMENTAL AUDIT, INC TO 03755123212094663403 P.05 <br /> EXYMONUEUTAL HEALTH DIVISION <br /> P D •352 d4S k SAN JCADOIA ST, STOCK;ON, CA *82 <br /> ,3gg <br /> 20) A68.3G2D <br /> Wol"EZORDARL'PERMIT Wm RFS 1 YEAR FROM OATS ISSUED <br /> ICaOaleta in TrarC w <br /> App[iootion is here try made to me San Joaq in r~^.tY `.or a permit to ccrisxr t aM✓ar install The Wort described. This atpIICatim is <br /> made in cool iance vi th San JoseVin Canty De1'elo.•-ent Titin, chapter 5-1115.3 and the Standares of San Jo.q in coviry pumt is Hee U` <br /> services, 'nvi rOrsvental Health Division. <br /> Jeb Addreaa/or APW$ 5400 Pacific Avenue cl;yStoektal P,rce[ site/uxe 2 <br /> cti -s xa,. Mont. Ward & Co. , Inc. Aedness 1331 S. Harbor Blvd, rl111le_rton CA. Phom x714-773-6227 <br /> contractor Environmental Audit, Inc.AddrasslDDD-A CktsaTFiv. P]aaltria$y05348 Phone *2 -632-8521 <br /> sm cceur7c-Or TEG Alsress_mxfler FE[6" Pl, Rxr D Lgeg ' ,hone $916-853-8010 <br /> TYPE OF VEIL/PUNO! Rev TELL ❑ ZVLA=-CER; L'ELL It ANTTORIRG WELL $1 & 2 4 07HER Hydro Punch <br /> C DESTRUCTION C OUT-CF-SERVICE YELL ❑ CZOPHYSICAL WELL it '❑ SOIL OORTWG <br /> IxSTALLATICH E: L>rIL STs7El4 REPAIR ❑ CRCSS-CDxNlCT REPAIR C VAPCA EXTRA.Cr ION 4-:U <br /> ❑ Now ❑ Repair H.P. DEP7H KW SET FT. FIRST WAi ER L-VEL ' C <br /> (TYPE OF PLW) <br /> 3T"DED USF TT7E OF WFu tomrIRUmax V 7millows \ <br /> ❑ I misTRIAL L CSEx WTTCN D[J.. OF LELL E=VATiOW DIA. OF CIDUROR CLSIxc - <br /> C DCMESTIC/PRSVATE :_1 GRAVEL PAWSIZe_ -,M OF CJSrxG/S:E�L/PVL DIA, OF WFLL USiWG - rJ <br /> D KMLIC/MUN[CIPAL ❑ DRIVEN: DEPTH OF ROUT SEAL � �- SPEC:FICAiIO$( <br /> ❑ IRRIGLTSON/AG ❑ OTHeR C7= SEAL IWS7ALL0 5Y ROUT SFWIO xAXE <br /> q }ICM:70R[xG <br /> GRa <br /> n r SEAL PUMPED: ❑ No =X=Eif. PEDESTAL aY DRILLER: C; Yes C NO <br /> 50 <br /> APPgDx.DEr"Ai L0=4 CHESTE-t Rta):-TOV£ PIPE r <br /> PROPOSED CIIISTSUCr1a9MXLLIRG '47HOD: AM ROTIZ_ AIR PO7ARY_ AL=R_ CABLE OTRER XHydro Punch <br /> rr� <br /> I hereby certify that I have prepareC this =Ll=tlW and that the wort witL oe done in ac=rdance With San J000vin COLtITY Cronras'xs, 1 <br /> 5t5te Laws, arc' Rules and Regulations of the San Josalin Can-y. HeOe Dune. or Lice=-ed agent's sig=wm certifies the felt Wirt: PI <br /> certify that in the per-'Mhsme, of the work for e..+i+ithis perwit is issued, 1 shall rwi e+epley persons subleC::tO'YC52xNAx'S C7ePc4SATIL'x <br /> Caws of Ca(ifornia." Caltraetor's hiring or sacenz=ing signature Certifies the folk Wing: e 1 certify :hat in :he Pcf-ot wwcc <br /> of the vcrt for vhich this Permit is Issuad, I &all ezeley per,uro. sj4ieo; to L^R104Ax'S CWERSATIOu Laws of C,lif Ofnil." -,XI APPLILCxi r <br /> MUST CAU 2 URS IN ADVA7Ct Fo -lkar 01 • UmECrim AT WS)484-3.:3. colete drawing at to r area Provided. <br /> mpBrent H.MechaRj,jeSenior Project Geologistoate1-30-96 1 <br /> 111111 1111 I I III I <br /> I I illl { IIl 11 will 1i Illi <br /> I Illilllli llllfl ! ! llllli <br /> 11111ili ( III II I Illllllli � <br /> DEPAATMEArr USE awl <br /> AppLleetien ACCLpttd 8y Date <br /> Grout lmpee:ion By Date F Insocc-')w ay. Date <br /> Destrs:ion Inspection 9y Date Ceseenis: 13 13 <br /> j <br /> UIFTI)m UNLY. AID$ - I FACT <br /> gg � <br /> PE LODES I FEE I1W I AMOUI[I REYUTTED CxF^.. =H RECSM DY DATE I PEINUTISERYIC'e REQUEST)CUMBER I DIYOICE i� <br /> 3501 S B I 39a.°° 132-32- /lti 9391 <br /> I I ! 1 I I <br /> TOTAL P.05 <br />