Laserfiche WebLink
INSTALLATION TYPE <br />11 HOLLOW STEM <br />I] AIR HAMMER/DRIVE <br />fl MUO ROTARY <br />OZONE tJ PUSH PoINT (GF. or <br />ri HAND AUGER <br /> I] OTHER <br />cue/ <br />ri DIA. OF BOREHOLE a MULTIPLE CASINGS MULTI-LEVEL WELL CASING DIA: <br />N CASING THICKNESS_.Se WO TYPE OF CASING: a STEEL Q crrHeR1 <br />DEPTH OF GROuT SEAL •TREMIE TYPE TO BE USED: a AUGERS 0 HOSE <br />CPT)GROUT SEAL PUMPED: El Yes b No (NOTE : MAXIMUM FREF-FALL DEPTH IS 30') <br />GROUT SPECIFICATIONS ft /)11At4X6i--%41-0—' <br />APPROX. BORING DEPTH /}c"- fl BOLTED TRAFFIC BOX or 11 STOVE PIPE <br />u TO 4 <br />signed JAC:-"Lr44LLJ 19-a-tte.. Talo/Company .Lo GaS71" <br />0111,51D4 Print Name <br /> :)/9 r r4 <br />Dale <br />DEPARTMENT USE ONLY <br />0.6/•;,1 a n. 15. 2007L110:44AM)46834:, <br />EHD <br /> No. 1080 P. 2 02 <br />San Joaquin County <br />Environmental Health Department <br />7 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 <br />(209) 468-3449 Fax: (209) 468-3433 Web: wwwico.san-joaquin.ea.usiehtcl <br />NON-REFUNDAI3LE PERMIT EXPIRES 1 YEAR FROM DATE ISS ED <br />Application fa hereby made I0 San JoaqtrIn County for s permit to construct enwor install Ma work described, Thie application Is made In compliance with San <br />Joaquin County Development Chapter 9-1 116.3 and the Stindarda of Son Joaquin County Em4ronmontal Haellh Deprunent. <br />WELL Location 4-0 a‘u.,,i7 41-3 Crossi Street <br />P0R:nef17,1;2-J _Address2201 ;dm cifdarn zip 9 4horuai (2-a ,) 196' <br />C-57 Controctor,/779, Addres5 cr,7 ,./4/970e, /6.)," city,AaAL51,.q_zipii.5-1/inicgt*Si6,5-Phonee (citr) ST-6)—C) <br />Conaultent / Su Crer E 12 Add,. 16 6 0 P-tAn:V't S City AiA'CAA'a--,Llc#7`Yt 2-0 Phonei 12 i) et k - 6 0 <br />GIS Coordlnales; X V TownshIP Range ' Seeders <br />MIRK TO BE PARFORMEU: <br />13 NEW WELL I BORING (CPT, GEOPROSE, HYDROPUNCH, HAND-AUGER, ()THEW) 11 DESTRUCTION (enclose typo balow) fl SDIL BORING 1:1 OVER-BORE. DIAMETER <br />1,1 PRESSURE GROUT <br />GROUT SPECIFICATIONS <br />COMMENTS: <br />TY • K ,.pE_IT L <br />IWO, NI TORING <br />n EXTRikCTI ON <br />g VAPOR <br />1:1 AIR SPARGEt <br />SOIL BORING <br />OTHER: <br />SITE <br />MITIGATION <br />UNIT IV <br />City ,a0 2_;-2e? irarceett° <br />n •Othor <br />COMMENTS: - <br />CONDUCTOR CASING PROPOSED Of YEE. Itot spielfloatione in conment section) <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS, <br />I hong)), certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br />County Ordinancea, Rules and Regulations, and all applicable California State Laws. <br />Application Accepted Byi <br />(3rout Inspection Sri • (<._. Date t _ 4 c(...) ) Plnal inspection By Date <br />Deatruotion Inspection By <br />COMMENTS / CONDITIONS, <br />SITE MAP IN UNIT IV FILE, ADDRESS: 3--40t LtJa,c. <br />WORK PLAN DATED: CO IR-A-J (2, c4- 12.,(74 , <br />,Data lesued ti/lo 'Nee <br />Dale <br />ACCOUNTING ONLY'. AID'S <br />PE CODES FEE INFO REc'D BY DATE <br /> <br />PERMIT/ SERVICE REQUEST*, INVOICE <br />bo 3cie 3 <br />o SR4 /5 '1 5 3 s3 <br />C-07 WC -WAIVER C-57 Letter of Author ZotIon to sign permit Encroachment doc <br />REID 29-02,-00I <br />9/30/2002 <br />AMOUNT REMITTED CHECK at