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05117/2012 08:32 9163390484 ATC ASSOCIATES INC. PAGE 06110 <br /> t <br /> SAN JOAQUIN COUNW <br /> - , ENVIRONMENTAL HEA <br /> LTH DEPARTMENT LOP <br /> SITZ:MITIGA11ON <br /> ; 60o East Main Street,Stockton,CA 852024029 UNIT 1y <br /> ;+ <br /> Tell'phohe.{209)468.3454 Fax:(209)468--3433 Web,wtr wa em-orf .— --- <br /> WELL & BORING PERMIT APPLICATION <br /> FOR WELLS AND BORINGS UgED FOR CONTAMINANT IMdESTI0A110NS AND RemamA1140N �� r <br /> �f3 •d�>rF1.,1Nb�Bt1;.PEFtMtY.' - �---�---. .. O :1 <br /> Rpsy1-jwa is"by made to Ban Joaquin C um for a pm-Alt to conwrLid andlcr kratalt tea watk-dascf94ed. 71ft-apoautian Is made In comoftnoa Whit star+ <br /> Joaq Oounty t*vailopmant Title.Chapter X1115.3,and the$tandards oaf the San.I0aq&n County Envfmnmmnta'H"ith Department <br /> Sit*t ocatlota S N ns�stt$et . ►�1 LA he 'ctty e3 —_z►p ` s Ito �I � <br /> pacf .e {�k7 ;�Addtess ztp ��3�b Ql;ar <br /> OWM'.- llc Ike F'Iwna 3! •5$t <br /> C•67 t;onha r �t � Address a 1I•` � �•�,�,� <br /> Cot�aaitt♦ntl34b Crttr R Address <br /> 8II1itI7taPnrty �l l 1 f AddreBx CItY <br /> GIs Coordiost m.X Y •,S Q l(o�q2 3' <br /> WG32 99REgaRI) <br /> HEMI WSL.i.r =MNG(CPT.GEOPROSE,HYDROPLtIVM HMD*MOeR,OTM IQ <br /> pIS&L IIeING IC3s <br /> CI OTHM Ina . <br /> �[�NtCAIrrORIh1G 0HOLLOW STEM W&OF90REHOL.E ©MUL-rpLS.CASINgS C7 MULTI•t.EMWFLI.WSINGOIA: <br /> �n gc7RACTIpt I;Ysporrwaltor 0 NAIr16dETilmwtN CASING TH=NE" TYKE OF CASINt3: 0 IMEL©PVC'© 0lm"- <br /> �[3$OIL VAPbR PFIOSE. ❑HUJD ROTARY 0j5pTN'OF GRWT JAL. 7R1 hIt TYPE TO 9E VSE-0- G AUGSRS.[}H055 0 <br /> � I Stitt 13f�FttWG 0 FU8H PaW(QRf t" GROUT•SEAL pt MpM:01I4s a mo(ilAAa IM M FREE FALL DE&H is 30 Fr) <br /> IN,�GTt03�fI,!►,�l f3 FIANUAU[3ER��.£3FtOL'rr 3PEOIFICATIDI4$ . <br /> ....�q' OTHI;IZ _APFROX•BORfNG wpim 0 9ULTeD TRAFF'IO BOX 4R "I3 STOVE PIPE <br /> gOADUCTOR CAMa 0 Nb 0 Trus!CaatrW Va:,.,_.Cal"Depth:,,,•.Smtr*DIC- <br /> Comm". <br /> IS}: ...,_Comm". <br /> NOT£: OFFSITE W8LLS 4 90FU GIS REQUIR9 ACCESS AGREEMENTS OR.ENPRO,A-CHMENT PERMITS <br /> EP OVER-9DKE{IWMSTEROF_JNC3 SSTOVM rH - • <br /> 4 FS}TO � $SURE-Ca WUT 1,00EM Or~ PT kkCpm jwACE <br /> Vol low, CI i=7; IVES FA*M TO _ FT OV.MV s s� <br /> GR01JT SPECIEIGATIONS 'musHRt?C><4I GAP AT rn-FF r BELCWe smmct <br /> TREMIE'I YI'E TO BE USEDi RUt3ER5 iiOSE 0 PIPE Q <br /> COMMENTS <br /> 5 WDRKINO DAYS NOTICE'FtEQUIftEq(AFT/=R PERM ISS11rANt )FOR iNSPECTiCiM!s►P>'OtN"CIifIENTs <br /> I here" th ve pmpu d lhts' olt ppacatlon Itnd dthewnlit will Ira don*twomortlanco with San Joaquin CasuntyOrtiinatrlclt9,Rules and <br /> -RIIbulatt a a Lft" t C <br /> 111ialGampeny <br /> PAnt� C's Date J �Z� /} <br /> DEPARTlNENIT:U.SI ONLELY 5t L_ (� - <br /> SI7CC MAP lAI L)NIIT IV I [[.E SttE ADDRESS T•� ' <br /> WORK PL,AId'DATED ti s <br /> ARPLICAWN ACC£PItO(3Y insR <br /> E <br /> GROUT INSP'EroMN By r/NAL IWSiyEC110N gy <br /> 6Y <br /> pESTRUCTiON INSPECTION UY allALW <br /> ACC7�UNfiV(3 G4lQt1': Atli O FAG# <br /> i Rog INYWCtr <br /> PE T S FEE IHI"O AMT REMrrrER CHECK S REG�1'I�BY bbTG RECtiIlEST PR 0 <br /> S' 0 �� SFt 40 r0 t?Q <br /> i f 25 is <br /> Sb <br /> 375' <br /> 366 <br /> PR V <br /> 1 <br /> C_57_ WC_WAIVER _ C5T LETTE,ROF Kj)-MORI2AMN TO SIGN PERML-F _E{UCROACHMENT I70G <br />