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+ <br /> Sep. 29. 2008 1 55P ATC GROUP SERVICES INC. _ No. 3449 P 1 <br /> 70,7 71 <br /> San Joaquin County <br /> Environmental Health Depart �� rS l\\II;,���� SITE <br /> 304 East Weber Avenue,3rd Floor,Stockton,Ct1d5Qk�'�IJ v L—yNITIGATION I <br /> (209)468-3449 Fax:(209)468-3433 Web wmvsjgov.o4ehd --- 0 i Y f <br /> Well Permit Application OCT 1 4 2008 f <br /> o NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DAT6WffiD)N%1E`NpI`H.E!'•CLTH - f <br /> Appliralon is hereby made to San Joaquin County for a permit to construct and/or install the wOfkdeac ��{ii9(�ppHtAtl��' Made in compliance with San <br /> Joaquin County Development Tile,Chapter 9.11153 and the Standards of San Joaquin County Environmental Hearth Department. ° <br /> Assessors <br /> WELL Locatten Io6 4)rs{ frlond Sf, Crosss"treat 9b(030 cdy /��G_.r 00 =zip 95366 parcere ?59 300 3 1 <br /> PROPE��TTyy 1Jt nn <br /> owner �(rr•dJ � llrr{/+�rT Address 27 31eCSoi, nr, Clry 0-A Zlp 9S3LG Phone*_ <br /> C-57 Contractor 6M. Or%/his 1 ' Add eLss 95'0 Nen/r 12d, 6;tyM"#,V Z zip 9YSS icq `�a5/6fPl one# 99S^7/?�SSroo <br /> ConsunantlSubCntr 47C Assori.ars 7.1f. Addross/1/7 Cone F3/w.krc.clryN•�r Llcd Phone# �e9-S79- 991 <br /> OIs Coordinates:X ,Y - Township a S Range Section -� <br /> i <br /> WORK TO RE PERFORMED: <br /> ' NEW WELL I BORING CPT,GFOPR09E,HYDROPUNCH,L�p_ND-AUGER OTHER*) 0 DESTRUCTION (choose type below) <br /> SOIL 80RING# �Pr �•fir.l G-Y1.5/rG ePT.Oor;rc aOVER-BORE. DIAMETER <br /> p WELLS _ pjyJJ,I�-/y-.rJU$ O PRFSSURE GROLTr <br /> a*Other F . GROUT SPECIFICATIONS. _ <br /> COMMENTS: <br /> TYPE OF WELL IN9TALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> p MONITORING. a HOLLOW STEM DIA.OF BOREHOLE />'��1]MULTIPLE CASINGS Q MULTI-LEVEL WELL CASING DIA: <br /> p EXTRACTION 0 AIR HAMMERIORIVEN CASING THICKNESS TYPE OF CASING: U STEEL D PVC lI OTHER: <br /> a VAPOR 0 MUD ROTARY DEPTH OF GROUT SFAL TREMIE TYPE TORE USED: D AUGERS a HOSE <br /> 0 AIR SPARGE/OZONE tPUSH POINT(GP orebROUT SEAL PUMPED:. 0 Yes p No (NOTE:MAXIMUM FREE-FALL DEPTH IS 301 <br /> )@C,SOILBORING aHAND AUGER GROUTSPECIFICATIONs A)r«i /Ywwrld- kro-d S)vfy. <br /> p OTHER;_G OTHER APPROX.RORING DEPTH TBD IOP-y0O •U BOLTED TRAFFIO BOX or 11 STOVE PIPE <br /> CONDUCTOR CASING PROPgSEO W& (H YES,list speclecaVons in comment section) <br /> COMMENTS. <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR,INSPECTION$. - <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, Rules and Regulations,and all applicable California State Laws. <br /> Signed a- /l-lQ -__- _ True/Company - pr•s�rr� Oro/sit/ �rC �Sfabi�iy'.'rnr, <br /> Prird Name 11 /47440 1 0 —0 7 -08 <br /> QEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: I D 6 SeG64 5+re6 l R 1 Oo a <br /> WORK PLAN DATED:/ J .tly 1/L200A <br /> Application Accepted�By�T//./7 ALdAiLLM Date Issued . / — S- rea 1451 <br /> Grout Inspecuonu <br /> 6y VIGi2r IdYYdc,//�r'3n , Date 2A-U8 FlnaHnspectlon By Date0 -27-0 <br /> Destruction Inspection By _T Date <br /> COMMENTS I CONDITIONS Z^) <br /> ACCOUNTING ONLY: AIDC FAC* <br /> PE CODES EOO <br /> FO AMOUNT REMITTED CHECK'! RECD BY DATE PERMIT 1 SERVICE REQUEST f INVDICE <br /> 35'03 89.00 <br /> 404.00 029418 yj�lJL" /0-/5-013 SR# OOSSG 87 <br /> C-57_ WC_WAIVER_ C-57 Letter of 4 Authorization to sign permit_Encroachment doc_ <br /> EBD 29-02-001 , <br /> 6/22/04 . <br />