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ent B GreggDrilling & Testing, Inc. • 925 313 0302' Au - 16-99 17:21 ` Pa e 212 <br /> Y� 99 9 9, .._,, 9- �� `amu b, <br /> 05/16/99 MON 1.1:35 FAX 53018781( <br /> .•. ...>A-05-1999 1 -See FROM V P.2" <br /> • WELL PERMIT API PLICATION FORM ;f UNIT IV <br /> j SAN JOAQUIN COUNTY P LIC HEALTH SERVICES - <br /> ' ENVIRONMENTAL HEAL H DIVISION(PHS-EHO) <br /> 304 E.Weber, Third Floo , Stockton, CA., 96202 <br /> (2091 <br /> t YEAR DATfy1EE11m <br /> '41PIc+.+'a�i hofeyy no"to San JOeauin Qa1tld M a Ps01i1 b ueehud i,nideG the wont sevlw0. 1This appWuden is myrtle YI aon4renm+im <br /> san Jwtetn CpME�rwp�,SIwPRM T410.aupb:9.1116,3 ant am,aft"dara.of Joawin Cewr Public Hoeft Sonia".Emi.u.. wj twin Diw.bn- <br /> VVEiLlarAtlarN I�UESi T1T.fNl� ;ISA Ca Stye" As�eawYs <br /> �Y LCAt may+ jauo ;o w <br /> ' PROPERTY O.—fler`rT Address f ICd1GYILlE <br /> cal 4 1 c�nd$+�`�a, s313�.X� <br /> ca,.dsrai sub ,•a/l � ne�I <br /> 019 coastlette:X. Y_ .TOuwtNP RaOpP _ ��— <br /> WDM tO DE F®IiOdYtSO _ <br /> WELL I WRING(CPT.OEOPROSE.MYDROPIINCH.W ND AUGFJI• -) . . a 0 OESTRUCTrON(chO type eeEtw) <br /> ,1K'SOL WRING I 0 OVER-WRE <br /> 0 WELL I PRESSURE GROUT <br /> coMt+EtITs <br /> 0 MONITORING DIA.OF BOREHOLEMIILTiPIE uSlNosi 0 YES Q NO WELL CASING Duw_ <br /> 00RRACTION O Aft N4AI1EWORIVEM CASING THKIMEss TYPE OF CASING: 0STEEL II Pvc 0*THER: <br /> 0 VAPOR 0 MM ROTARYDEP1H OF GROUT SEAT. 'TREiLIE TYPE TO Be USED. O A4IOEns <br /> pAIRSPARGE _ DPUSHPOINT ,z _ GROW9EALPLSWUW. 0Yee 0Me (NOTE: MAXMMFREE-FALLDEPTH EI <br /> O 504.BORING a"AND AUGER APPROX.WRING DEP <01 D BOLTED TRAFFIC Bao( a 0 STOVE PIPF <br /> p OTHER n OTMER— COMM)CMR CASINO F ROPOSE07I if YES.IW speciA &tjww hors): . <br /> cwtrBldTo <br /> NOTE: OFFSITE BORINGS REQUIRE ACOESS OR ENCROACHMENT PERMITS <br /> I Nreby aw"wet 11rw PrsPerw em appamum mw am aw plat w H tMmrtlents Aneglrtn CePeb OIs wew. <br /> r. .,.d RepMlw,s d e.Sen JswpA,COW"W. Nstn 01411 0r 40 d apl rads <br /> e4 w otwl9es Ito Tars,at.d Rtwes <br /> Itrah-h w/sP—wMLo Ierr41 saE,we 1°I^+AO:7 rtrrelry•ewr6i w.prAb nwo.aw..wt <br /> adpleaae m tro aw sropbG•pasews srlfrcf b COMIP60SATION Iawa afcY%FnjoL' OOMfedae Nino a saa <br /> TION Lewd CsA6rr lM/NwePe,It+wu�+Asd wvk Ar W*n Ill Pwtw.th+1-041lAll amotsyp mom see/eclb <br /> AOPUCANT LL 48 HRS IN ADV NCE FOR ALL.REQUIRED INSPECTIONS. <br /> Sate, <br /> SEE SIT MAP I pppN UNIT IV WORK LAN DATED <br /> t App6cft 0 ACN"WBY /{C 1rr4'C.( DEPAMMENT ME ONLY - 1 <br /> D.Ie lwns / 9 tae Lo <br /> Dwaclan Inkopmen By Deb Fitt a*p+dbn ey p , <br /> D.wuoloe I D D� <br /> cort16Ntsi <br /> 4CCO{AdryhlG ONLY: Ap/ <br /> PE cODEs FSE NFO AYOIIHT REWTTEp St/ RECI VEDSY OATS I Pamrlam"cu REQUEST NONOlR 'MOMS <br /> o` ii 4z <br /> �V•(L 1a p 6 <br /> r <br /> tn•ar=Y_eixarolisgntlgyiw>; .. . _ . _ ..w.. _ ... _.. . . ... ____ - ... . . <br /> 1 z i <br /> 1 4, <br />