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WEL60�Ei4MIT APPLICATION 04RM <br /> SITE <br /> SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES MITIGATION <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD UNIT IV <br /> 304 E. Weber, Third Floor, Stockton, CA., 95202 ° <br /> (209) 468-3449 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED AUG 4 2000 <br /> Application Is hereby made to San Joaquin County for a permit to construct and/or install the work described. This applicatE <br /> ERT- <br /> Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Public Health Services,'EnSan <br /> � <br /> WELI-Locatlon 8751 E. Highway 12 CrussStreet Bruella AveatyVictorzip 95253 Parcel# <br /> PROPERTY Owner Dole Food Company IncAddress]0900 Wilshire B1vgSdCiiy.16S .pp <br /> agelemp 90024 Phone#_3107824-10_23 <br /> C-57 Contractor Spectrum Address2365 Wigwam Drive City Stocktonzip95295uc 512268Phone# 209-465-8.212 <br /> Consultant/Sub Contractor Geomatrix Address 2444 Main St.#21�ItyFresno Lic#AEM4�51,Phone# 559-264-2535 <br /> GIS Coordinates:X Y Township 3N Range 7E Section 4 <br /> WORK TO BE PERFORMED: f <br /> *EW WELL GRIN (CPT,GEOPROBE, D PUNC HAND-AUGER,OT �y��1 0 DESTRUCTION(choose type below) <br /> SOIL BORING# V 0 OVER-BORE <br /> 0 WELL# 0 PRESSURE GROUT <br /> `Other: GROUT SPECIFICATION Cement--bentonite <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> 0 MONITORING HOLLOW STEM DIA.OF BOREHOLE 8" MULTIPLE CASINGS?0 YES *O WELL CASING DIA:N/A <br /> 0 EXTRACTION p AIR HAMMER/DRIVEN CASING THICKNESS, NIA TYPE OF CASING: 0 STEEL p PVC 0 OTHER.NOrie <br /> 0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL BOH TREMIE TYPE TO BE USED: 0 AUGERS *OSE <br /> 0 AIR SPARGE 0 PUSH POINT GROUT SEAL PUMPE=D:)(es 0 No (NOTE: MAXIMUM FRET;-FALL DEPTH IS 30') <br /> ){,SOIL BORING p HAND AUGER GROUT SPECIFICATION Bentonite Cement. Slurry _ <br /> 0 OTHER:_0 OTHER APPROX.BORING DEPTH <75' 0 BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> CONDUCTOR CASING PROPOSED? None (if YES,fist specifications here): .. <br /> COMMENTS: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACH MEN y rEMEATtJ <br /> I hereby certify that 1 have prepared this application and that the work will be clone in accordance with San Joaquin <br /> County Ordinances,State Laws, and Rules and Regulations of the San Joaquin County. <br /> * CALL T E UNIT F IN PECTOR 48 WORKING HRS IN ADVANCE FOR ALL REQUIRED INSPECTIONS <br /> f <br /> Signed Title/Company. Senior Engineer,Geomatrix Consultants Inc. <br /> Print Name Veen Chee Foonp Cate <br /> SITE MAP IN UNIT IV FILE ADDRESS !WORK PLAN DATED <br /> n DEPARTMENT USE ONLY <br /> Application Accepted By " —/ r Date Issued U l 0 0 Area 1 <br /> Grout Inspection By Date Final Inspection By Date �I Oct <br /> Destruction Inspection By Date I; <br /> COMMENTS!CONDITIONS: <br /> ACCOUNTING ONLY: AID# FA <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK# REC'D BY DATE PERMIT I SERVICE REQUEST# INVOICE <br /> 3So �6`I '� a ods 7 9 I <br /> C-57 WC/WAIVER C-57 Letter of Authorization to sign permit Encroachment doc 7/17/00 <br /> I i y <br />