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WELUPUA/tP PERMIT <br />' <br />SAN JOAQUIN COUNTY1' ENVIRONMENTAL 1' DIVISION <br />1' THIRD .O . . 1 (209)4168-3420, <br />14ON-REFUNDABLE PERAffr EXPIRESFROM DATE 1 <br />I'- <br />JOB ADDRESS AFN <br />CrTyrim, rl <br />crryfzlp PHONE <br />CONTRA ADDRESS / /,:3 <br />GEOGRAPHICAL1 • .COORDINATES. 1'SECTION <br />TYPE OF 1, ■ REPLACEMENT WELL . MONITORING WELL# ■ OTHER <br />INSTALLATION: 0 WELL SYSTEM REPAIR 0 CROSS -CONNECT REPAIR Ll VAPOR EXTRACTION WELL* <br />i <br />TYPF / ■ FIRST <br />i <br />■ • • ■ GEOTECHNICAL ■ •I :.• . DESTRUCTION: <br />CONSTRUCTION CInCA119N <br />JINDUSTRIALWFIT-EXCAVATIONDblIr "• <br />1 <br />• •• ■ rE- WELL CASING TYPE WELL CASING1 <br />I <br />tr<pLlCfMUNICIPAL • <br />DRIVEN GROUT SEAL DEPTH.terSPECIFICATION{ <br />1 <br />IRRIGATIONIAG OTHER GROUT BRAND 1' <br />■ MONITORING GROUT PUMPED: ... <br />1 <br />■ 1• :• ■ CONCRETE• .• u ■ • <br />APPROXIMATE WE1 " <br />PROPOSED CONSTRUMON/DRILLING METHOD; MUD ROTARY- AIR ROTARY -AUGER -CABLE -ZOT"R <br />HEREBY CERTIFY1 THIS APPLICATIONI IIIAT THE WORKI DONE INACCORDANCE <br />JOAQUIN COUNTYORDINANCES, 1 1 RULES AND REGULATIONS.•CERTIFY CURRENT <br />1 '•' • • BOARD 1 1•WORKMAN'S <br />COMPENSATION <br />MINIM`•UR ADVANCE• r 1 f OR INSPECTIONS <br />SIGNED __li� 4ala.�...r..�r .. LDATEr <br />...l�... .�.....L1.. ...A...........0. <br />.. .. �ZC�..^.�.OTWwwww.��.......�.Y.'Y. <br />.....�I.wBr����rAd Kl......�...II�rY1....1.�:'•. <br />•�•YME NEEA1.1`.�v 1 <br />.... _09 ME <br />r'/di.�`-.. . �. <br />....� C �................Y.1.��11111A.1..... WEI <br />.. .11�l........... IMMEM! !/G� l.s/l 612ARk IL\...E.. <br />..r rl1...........mmmmo..►`lilJllJlmm:.■011�.ilow <br />....tlI*JIBE mm—wwww.. mommm WHIM �Maimmixi'L'Jllill�l...1Im <br />.. am �wwwwwYYYwiwwrG'lIi�l�itsil�.1�...IA...MIl. <br />�. ...I�i.............. IME o mom M -...■IN <br />...s`I...0 IMEMMI M......M?L*MM 1.mummil <br />..... �11..No mm..............=��� l <br />.....�I....................ON ON �IMEM M <br />IME <br />I N`�IIIME! m mmmo ::� :C::..�.�,,l�La:::0 :: <br />IN INIMM IMI .NMMIMM ....moris ...... <br />... owl =11IMEM mm.........0 MIMI ......No MEMI. <br />C ........M mmmm <br />o__ .. <br />......1•.................C.C� --�]a� omm m.. <br />C���C�:�:�GC� '�_ �m�®Q®Cm��::M:M:� <br />Appfffttion-Accopt'Grout <br />Imp-ri . By_ - ' • <br />1 .: <br />COMMENTS: .� • . <br />.� . <br />• ® 1 <br />1• <br />• . I ^. 1111 i <br />