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09/06/2007 11:42 9166385611 CASCADEDRILLING PAGE 02/05 <br />09/05/2507 17:24 53.020816©4 ETIG ENG. Oft AND r•+Av= W4e no <br />San Joaquin County SEP - <br />Environmen�tall Health Department 1 3 2007 SITE <br />ti <br />600,-E, Main Street, Stockton, C.A. 95202-302 MITIGATION <br />MITIGATION <br />209) 468.3449 Fax: 209)'68-3433 Web: WWW,sjgov.o> `NMENT HEALTH UNIT IV <br />IT/SERVICES <br />Well Per it Application <br />N©N-REFUNIIABLE PERMIT EXPIRD9 4 YEAR FROM DATE t8$UEb <br />ApPMIM is 11Afoby made to Ban Joaquin County for a permit to c6natruct and/or Install ft work described. 7It13 application Is mdda In 04mp1iahCA udth San <br />EE <br />Joaquin County oeveiopment r&!, Chapter 9-1115.2 End the stanoards of San ,leaquln County Environmental Health Department. <br />At;99RSor$ <br />WEtf• Location 3306 N, EI Dorado St Cross S" rant F. Euclid AVO. City Stockto�lp 952 4 Parcet# 115"13'Ofl6 <br />PROPERTY First Baptist Church Addreall 3305 N. El <br />owner <br />0.97 Contractor Casonde Drilling, lnc. AddMaa 3832 Or <br />ConAultant / Sub Gntr RETIC Engineering, Inc, ddress— <br />oiS Coordinates; , Y <br />WORK _T.W_�P PRMEtia' <br />I NEIN WELL I BORING (CPT, 000PROBE, HYC <br />Ij SOEE, 90PING 0 <br />g WELL # <br />q *0thar„w <br />ado St. Clty Stockton rip 95204 phone# 209488^4368 <br />ate° s�7�€2 <br />Fa— <br />circle nitv�nrrinvsa 7_lo LIc#717510 phow91t3L638»1169 <br />5 Morello Ave.PIeagat7t LILk 624022 Phone# 925-002.4710 <br />City WillT,cll <br />T4wnshIP 2N RBnye LIR Section 34 <br />HAND-AU05R, OTHER*) G DESTRUCTION (choose type beiaM <br />Q OVRI2.BORE, OIAMETER� <br />U PRESSURE GROUT <br />G ROUT SPSCI FECATIONS <br />TYPE -OF -W.91. 1. IIlSTA4l„q ? CONS 3 Ia 0N 9PECIFICAT.. IO 201 <br />MONITORING a HOLLOW $TSM DIA. Or 6IOREH0I,.E $^25, II MULTIPLE CASINGS U MULTkLEVEL WELL CASING CLIA; 2 <br />Ii i.�G. TIRACTION Q AIR HAMMER/DRIVEN CASING SCh, 40 TYPE QF CASING; a MZL IPVC A OTHER: <br />CP <br />U VAPOR a MUD ROTARY DEPTHHCItP GROUT SEAL26- TREMIE'iYPE TO BE USED; j,[ AQGVAS p E 10$fi <br />9 AIR SPARGi;/ OZONE U PUSP POINT (CP or CPT)GROUT V1E At PUMPED: 0 Ycs ONO (NOTE., MAXIMUM FRED -FALL DEPTH IS 30') <br />$011. SORINF n HAND AUGER GROUT SPECIFiCA1'IoN3 Haat cement t�reut <br />O <br />OTHFR', U OTHER APPROXI BORING DEpTTH^A51t _-- ..gS3tll-'fETD RAFFIC BOX or jj 9TOVE PIPE <br />. <br />OONOUTOR CASING pRDPOSED no„(If yF3, list spedriicailtlns In comment section) <br />COMMENTS: II <br />NOTE. OFFSITE SORINOS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS, <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />I hereby certify that I havepreps this applicaltlbn and that the work will ba dOM@ in accordance with San Joaquin <br />County ordinan , Rules an ulations, and SII applicable California State La". <br />Signed, TltlelCompany^Iyl� Y' <br />-m c Date b� <br />Print Name <br />DEP*RTMENT USE ONLY <br />SITE MAF" IN UNIT IV FIDE, ADDRF5S; <br />WORK PLAIN DATED; K 3n c <br />Aploftntitln AMpted By Date Issued T� <br />�^ Dal e z8 02 pinal InJpeotSon By /A��� DAt9 <br />Grout InspeoUon By <br />Destructlon Inspoctlon BY tic --- ^^- <br />QomM Etd7D ! CONDITIONS: <br />ACCOUNT NO ONLY; AID# Cda <br />PE CODES FEE INFO AMOUNT REMITTED CHECK01 REC'n 13Y DA -M PC <br />iso \ SPU 1A 6 I `t 0} S <br />C-Eij _.„ MhC__ WAIV�R_ C-57 Latter, of Atithari7ation to sign permit_ <br />V,HD z9-o2•oozwcb <br />02/rt4 <br />.5 <br />R Ilrrvolct� <br />