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Q002 1 <br /> PORT OF STOCK'TON f- <br /> F_ f 5/22/00 15:24 $208 .QB5 7244 19002/002 <br /> 0/X5/2000 ?BION 11-31 F-Z 916 4101 4 W DRILLING INC <br /> t3C ON .-- V W DRILLING INc @jao2 <br /> PORI aF S'T KT <br /> 05/15/00 Zo:as '$299 48� 7244 UNIT 1V <br /> WF—LL plERMIT APPLICATION FORM <br /> SAN JOAQUiN COUNT`l PUBLIC; HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) <br /> 304 E.Weer,Third Floor, Stockton, CA., 95302 <br /> {205} 468-^s44S <br /> lyp FUNDABLE PERF1117 F3P1F�g <br /> AR Fi3Chi DATE iSSUtO <br /> mads to Son Jemclwln County for a Fern to cacsstrvrS andme hss:a ll Eho watk described 31zis appifeaUan lv m�da li �-mptignt�wil <br /> 7pYealton l5 t1G►Otix end the S:andwcfs of San joaavin Covnty Public Health Setvi=f-,Sn"i on���s sant'Oiri:ton. <br /> Gat my Devi->oP�t Tlae-Chapter 9.1115 � � O' C9 <br /> Sa:tJaa4uln ' ���lfc-n z{.j?��areeTQ <br /> Sf�G sf!�t Z Cro s 5 tett Q/1 City Sr �_ --0 <br /> r <br /> ,,EL-L,1 ocstiaR C �Z Oj '✓l 11 '3 en �T City Syal Zlp�r'`/S1Phanec <br /> C+wn� �1 T=�f16 T 1 address �r C!/ <br /> pItCPERT'r �e �Q, s � Gt:y 6rD j5fl- Ztp�7r /'L 7�phonc. <br /> r Address phone <br /> t�57 Canuador Add GgYr�U�r"---� <br /> rzs5 <br /> C,r,,-vltantI5udeontractos 1 IV L , —Se�>>n <br /> Q 0.3�� .Y . 733 .i'owr,ship <br /> GIs Coo,dm%Its:X 1 7 a <br /> wc4 T4 13E PEit!`ORAItED �DESTRUG710H Echaa>to type below <br /> p C G aPR66E.HYbROP:IAIG`i.1'iAr10y4UGER,OT�iEA'1 a OvrR BOR£ <br /> 0 H[Wµ 4L!BO ING t P7, £ XpRESSURE GROUT <br /> a SOIL 50RiN13 T <br /> L P ars Ina Pr'�rr U&crc�2r �`Or• a <br /> 'Otl,c� <br /> j} fucTion �t�rar- , ry <br /> COMMENTS: <br /> u <br /> 7'fP �L INSTAL TIOt+ P!" C6NSTRUCTIQH SP F1dNg <br /> HOLLOW STEM DIA.OF 60REHOLp��NIULT1PLl:CAStHGs't]YE8 YNO YELL CASING DIA_� <br /> JLMONITOKlao X THICKNESS.; Va TYPE OF CASING-'. Q ST>=EL JEPVC IJ OT'HZPt� <br /> d 7Rr+G7tOt3 iJ AIR HAMMERJr�RNF.M CASING T12EMItw T7PE TO 8c C1SED: 0 AUGURS j�1-t05E <br /> a EXTR; >]MUP ROTARY 0EPTi-I OF GROUT SEAL. <br /> 13 AIR s>=RitG6 PUSH PORI-, GRbtJ r SEAL PUMPED: a`Cap p No (NOMI-:t�,7Ax1MUM FREE--FAEl LL O EPTH lS 34'] <br /> SOIL SORlhft; I1 4iAND AUGER <br /> F,PFROX,BnRING OEPTH X6oLTEO TRAFFIC BOX or !]STOVE PIPE <br /> o d7E5 TSstspociGgtiarwt+era): <br /> Q OTHER��OTI1E GONDUCTt71i CASING PRO?tJSi?b. <br /> - <br /> COMMENII's <br /> Y1S'aZ Q�1' rl� -'� <br /> pell <br /> Hp�E; OFFSITE BORINUS REQUIRE ACCT-SS OR ENCROACHMENT PERMITS <br /> 1 horst f sonify tl+at t ha.e Prepared this avpiiestian ar..Nat I1�e wort.vrll ba dens in acro:dyr+ee with San�OS4eirsunly Ordinznc�s.Sta>e Laws,and Rv�s <br /> and Regulations of the San laaquln county- Homaawner at{it6nsad agent's signature certifies dv--f0maviing: -1 earvfy that in the prtrlonrrance of the work <br /> for whish thlr perr.�Frls issued t shalt not emp10YP 'sans subject fa WQAK5As'COI(pFusa7loN Laws v/t;alrfarn;a.' Cor,tr�dors Alting or si b- <br /> canGauing sgKat�re C6r .04 rho lallowEng:1 cc r, 3r that,n u";psrfarnanre c/Ac work forwh+'Ch this pwmr2 is issued,f$""smployparvm sub v to <br /> yyORKERS'GOMPEN54TTON Laws of Califomia.' <br /> ALL THE UNIT IV INSPECTOR 48 WORKING FIRS 1N ADVANCE FOR ALL REQUIRED INS ECTION . <br /> Y <br /> Signed Y illtiCompany - _ <br /> Print Name <br /> SEE�;:SITEy <br /> 13EPARTMENT USE ONLY <br /> Cate Issued —e'3—0-V Ar.ER <br /> Aapr'a=fi:n A=pted BY D3tC�r <br /> Grent GnDection By Date Fina{1n5PeCt7on By <br /> Snate s/zs/ao — 3 A W i ce -IVye <br /> Deslnreinn I41CPecl1on y /LsF" <br /> COMMENTS f CONDITIONS, <br /> --------------- <br /> r <br /> ACCOUNTiNG'QTn_Y: A10C FA&i <br /> N7 REMITTED FrECK t�sC'tS 8Y DATE . P?RMIT l SERYIC6 RSOUEST P, (;(VOICE <br /> pE CobES F£ UE INFO Ah'IOl <br /> 1/1a/�taoo <br />