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10/06/2003 10:42 209334 1 WGR SOUTHWEST LmPAQeFL <br /> Oct 06 03 11 :25a Wane woodward 1-707-374-5677 FILL-topy <br /> 10/06/2003 09:58 2093345374 WGR SOUTHWEST NoCAL PAGE 02 <br /> &- WELL PERMIT APPLICATION FORM LOP & SITE <br /> CQ W SAN JOAQUIN COUNTY MITIGATION. <br /> V 1 C-- ENVIRONMENTAL HEALTH DEPARTMENT(EHD) <br /> `Jl� IV <br /> 304 E.Weber,Third Floor, Stockton,CA.,95202 UNIT <br /> (209)468.3449 <br /> �I4N•RE�NDAt'JLE P�RIYirr�XPlRig 1 Y£�R fTtGliibATlc r8!!L� I""`"'l X 3 <br /> AAAestion Is hemby mwe b So Joaquin County for a permle tD o0"trWO V410C install Dw wait Aerorlbe d, Tri!!sppli=%on i$on*in oompilsnCp�ih San <br /> Jaegwn Cowrty DC-Wom tent Tills,ChapMr 0.1116.9 and the 8lsetdares of San.Imquln Count'Env0x mentvl 1 NlWt Deosdr mm. <br /> WELL Loagion `R7 /e /S £ �?`Cross StreetCity 4 Ir�.,.. np c9 A'14 ga pe <br /> 7E 1t' <br /> PRo�TYov�� S' 4= br,�d w. �ty�lnc]��a 3Pt,cnerC X446-da�/t <br /> C-7Co►1ocw ddn �.o. 13r _33G G1ty pt Zip9`t5�t LIaM�ab Fhon.#t -•r3ab <br /> GonsultsnrlSubCna, roas?,1S�yQ;ne�1 UsQCltytid55�_SS PhoneltralO9� �'�-S�1L� <br /> N ars caoroirta+ee:x 3 °_ S�. <br /> 'y lal a lqOSx 7, .Tbwnahlp ftangr Se6on <br /> 1 <br /> MOILT0 RE PEREORMER <br /> )I�EW WELL i BORING (CAT,GECPRpgE. YD <br /> NRQ¢UNcm.HAND-AUGER, 7 0 07HSRDESTRUCTION (choose 6De petoy} <br /> a SDtL DORM a I 0 OVER-BORF- DW&TER <br /> ,WL1.0_ a PRESSURE-GROUT <br /> 'ahw + 6C <br /> i <br /> C0L*'v�1'S; GROUT sPIF1cAT <br /> Tye OF wr=n, CON sPRcW.ICAT1oNs <br /> xMOwMNQ )k"OLLOW STEM Dia OF 8OREHOLe -1 i"D MULTI"CASINGS Q MULTI-LEVEL WPLL CA2WG DLA <br /> d EXTRACTION 0 AIR HAA4 tAAMRIVEN CASING THICKN=%L" q0 TYPE OF CA RING D STEEL QVC p OTHER; <br /> n VAPOR Q 14U0 ROTARY D£P?M oR GROUT 5F� s �. TREMIQ 1wIR TO W UIS, <br /> p A.UOERS 0 HOSEIP►/C <br /> 0 AIR SPARGE]07ONE D PUSH POINT{GP nr Cn GROIN SEAL PUMPM: Ia Yes J<W (NOTE.MAXjMUM FREE-F L DePTH 13 3137 <br /> p SOIL 90RING p HAND AUGER GROUT SPECIFICATIONSa <br /> '��4 tom, c"..�r, <br /> El OTMER n OTHER APPROX.ROBING 01=PTH oLTED TRIC tdOX or Q STOVE PIPE <br /> Cd1UNNT9: <br /> CONDUCTOR CASINO PROPOSED P yes.lifft,,PMMCX#W4 m � <br /> OD ,t,.$„y <br /> nk ,,, <br /> NOTE: OFFSITE B NQS REQUIRE AC ESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKIN(3 HOURS NOTICE REQUIRED FOR INSPECTIONS, <br /> I hereby COMIly that I tiW9 pfeparad Oft application and that the work will be done In accordanca with San Joaquin <br /> County Ordinances.Rut s tsrfa Dulat! 00 Sit applicable California State Laws. <br /> Signedz�/ '� T-ft ompany <br /> -�—_,FAY"/CC�'�✓G <br /> Prat Name Dau_ lb— <br /> OI;P RTMENI USE ON q / <br /> SITE MAP IN UNrr N FILE,ADDRESS.- <br /> WORK <br /> DDRESS:WORK PLAN DATED: (� <br /> SMklldon Aeeeptttl By Dais Iltsusd <br /> grout blepeptart 6y Data_ Final Ineperpon sy=_-.n- o woo <br /> �esAuWoe n Dpte y <br /> :MUMF TS•1CONDM0NS <br /> A=UNTINQ ONLY., AIj <br /> FaClr - <br /> PE CODES Fff wo AIIOuw REMRru CHE K,0 RECD BY DATE PER1Wt l SERIfi E REQUEST! <br /> C) (P� 1l1VOIC6 <br /> X57 we " f o sR 003553 <br /> W�I1IE�, C-57 Letter of Authorizdtian to sign permit thmant doc` <br /> 9f30/02 <br />