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09/06/2007 11:42 9166385611 CASCADEDRILLING PAGE 04/05 <br />09/05(2007 17;24 5102001604 E I IU LNU. IJAKLAND r-Hur- 041 rj� <br />San .Joaquin County <br />Environmental Health Depart><IllleUt SITE <br />600 E. Main Street, Stacktort, C,A, 95202-3029 SEP 13 200MITiGATIGN <br />(209) 458-3449 Fax; (209) 468-3433 Web: warwzjgov.UNIT IV <br />` 0190NMENT HEALTH <br />o Well Permit Application PERMIT/SERVICES <br />NON-REFUNDA190. PERMIT EXPIRES 1 YGAR FROM DATE ISSUED <br />Application Ia hereby made to Son Joaquin County for a permit to construct and/or Install (110 Work desortbed, Thl9 application Is made In Compliance with San <br />Joaquin County Developmont Title. Chapter 9-1115.3 and the Standards of San Joaquin County 5rMranmonW Health 02part ant - <br />WELL Laontion 3232 N. EI Dorado St- ss �. AI ine Ave. � Stockton p 95204 Assessors 125-98.001 <br />Ora,, Slroet P Ci Zi P jr0qltk_. _ <br />PROPERTY Robart A. Sullivan 3232 N. t=1 Dorado 5t. Stockton <br />Owner Addregs_ ,,,, Clty Zip 95204 Phone# 209-94&0501 <br />Rancho <br />0-57Contractor Cascade Drilling, Inc. Address 36$2 OgteC Circle CityrdXdQya Zip957A2 Lic#x1x510 Phanelt 916.938-1189 <br />ETIC Engineerin9q, inc. 2285 Momllro Ava. Pleasant <br />Consultaltt / 3ub Cntr _Addross City" LIdA 82422 Phorteti 925-60Z«Qi'10 <br />GiS Coordinate.: X� Y Tc mahlp 2N Rarigm CE Se 606 34 <br />O?tIC _.. _K Td >zE I+�;RFCiRMCD_ <br />,I NEW WE LL / BORING (CPT, GEOPROHE, HYDROPUNCir., HAND -AUGER, OTHER') 0 DESTRUCTION (choose type belov ) <br />>a SOIL 80RING # 0 OVERBORE, DIAMETER�T <br />H WELL 0 MWS Q PRESSURE GROUT <br />9 *other GROUT SPECIFICATIONS <br />CCIVIMENTS; <br />TYPE Or wELt IN3TAIJ,ATLON_TYF'"E CONSTRUCTION SPECIrICA-nONS. <br />it MONITORING A HOLLOW STCM DIA, OF SOREWQi,F, 5" a MULTIPLE CASINGS 0 MULTi-LEVEL WELL, CASING DW <br />0 EXTRACTION Q AIR HAMMER/DRIVEN CASING THICKNESS Scn^ 40 TYPE OF CASING; I] STEEL H PVC ra OTH;lk <br />Q VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL 26 ft- TMeMiR TYPE TO SC USED: B AUGERS n MOSS <br />0 AiR SPARGE/ OZONE U PUSH POiNT (GP or CPT)GROUT SEAL PUMPED: n Yes a No (NOTE: MAXIMUM FREE -FALL DEPTH IS 301) <br />(a SOIL BORING 11 HAND AUGER GROUT SPECIFICATIONS neat cetnent grout <br />n OTHER: n OTHER APPROX. SORIN(O DEPTH 45 ft 3 BOL7rz0 TRAFFIC BOX or U STOVE PiPI= <br />CONDUCTOR CASING PROPOSED no (if YES, rat speccifications In comment aection) <br />COMMENTS: <br />NOTE: OFFSITE WRINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS, <br />48 WORKING FOURS NOTICE REQUIRED FOR INSPECTIONS, <br />I hereby certify that i have <br />County Ordinanc , Rules <br />Signed x <br />Print <br />SITE MAP IN UNIT IV FILE, ADDREE <br />WORK PLAN DATED: 4130(c, - <br />this application and that the work will be done In accordance with San Joaquin <br />ilationc, and all applicable California(�S�W@ Laws. (� �I T� 1 <br />- T11lo/ComPany 1 Cjd , Lit <br />_ . �.. v G,6 ,A �. V Irl l YLG� t <br />nate 61 �~ d -7 <br />DEPARTMENT USE ONLY <br />— (4-e507C".N ►30A'1'o e S" <br />AppllcatlonAccepted By DAtelsQued_.-_--914 t6 Area <br />Grout Inspection Bye-,,,,,, I Inas Inspection By I4n vrnr'C�j A— Date / <br />Destruction ins action Ei Date <br />COMMENTS / CONDITIONS: _ <br />I Ise, <br />ACCOUNTING ONLY: <br />AID# FAC4 <br />PE COOM <br />Fi36 INFO <br />AMOUNT REM TIED <br />CHECK* <br />REC'D BY <br />DATE <br />PERMIT 6T # INVOKE <br />3 so, <br />43- ta.w <br />z1tT90L_:3- <br />c�,� <br />�, t� <br />SR®pS t `i s y <br />C-57— WC_,.WA1VE1? C.57 Lotta_i~ of Authoriantion to sign prerinit_ oc_ <br />T314D 29-12.0n I wdh <br />(7i22rod <br />