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06/22/2004 10:51 7144492991 BC2 ENV <br />06/22/2004 06:36 510-636-._.D1 BC2 ENVIRONMENTAL <br />DS -22-2004 00:22im Fror-9ROWN A CALOW91.1. 1-8�A-A 28-9180 <br />Sans Joaquin County <br />Environmental Health Depalrt)olaent <br />304. BaSt Weber Avenue, 3rd Floor, Stockton, CA 95242 <br />(209) 468-3449 Fax; (209) 468.3433 Web: www-� gcv.orgland <br />r90N-aEF3INPASLE PERMIT EXPIREe i YEAI! FRAM DATE rssv= <br />PAGE 02 <br />PAGE 03 <br />T-878 P.002/002 F-1 70 <br />SITE <br />MITIGATION <br />UNIT IIS► <br />A001catIM Is heMby mado =San J03011n County for a permit to COnstud and/or h•,efAU the work described. Thl3 appilcauan o rn20? in eompAanca VRt Sart <br />Jospuln county DevdopmOntTitle, Ch07er9-1116.3 and the Standard ag of San Joegaln CoUnW Errvtranrnentai health 0opaArn9nL <br />oes <br />tlypLLl.oeatlon,� c!k4••d P'�e <br />h Cromstroot ViG� Illy p 52 0 peoai IS y,'t`�a`-O�-WGS► <br />PRoPERry/', <br />C47 contractor ��L 1'/� rF1lL►n W@I+e l�tldr�s I L� ...f� ���t�rP. Zly f�rJ�,{ r� +q 6�� n,,,alp�// l• 'y •y-�7�e <br />ConstAtcntISubCnfrJ ati.M �r� �+� -+ QUO Xr�q� 50,9 O rl, - QLier! phetla# 71 <br />%ACCro� EFa• <br />GIS Coordinates, X Y A/ A Tcrosmip 7'U Range Se@torr <br />wo;3K TO SWEEPRMEC$ <br />tKN6W WFLL / BORING (Clk GEOPROME HYDROPUNCH, HAND-AtlGEK, O-NER-) a DESTRUCTION (ohopsa ape beGaw) <br />FOIL BORING a Ot/Iz-ii-MRS. DIAMETER <br />Q WELL Sa 0 PFR.ESSURF_ GROUT <br />Q'Other GROUT SMCIFICATI DNS <br />COMMfi.NTS_ <br />-ELL0n!A 1„4 1 N TYPE CONIMUG11 N!U!r.C1QCA-n2NC <br />Q MONIPORENG .HOLLOW STEM DIA, OP ROREHOLAjj��LTIa4E CASINGS Q MULrt-LEVEL VVTL&CASING DIA: <br />Il EXPAACTICN D AIR HAMMERMFUVEN CA61NG TljlrK VESS�-A- r PE OF CASING 13STEEL 0 PVC d E <br />OTHR: <br />0 VAPOR D MUD ROTARY DEPTH OF GROUT SEAL, 70 TREMIE TYPE TO SE USED; JEAUGERS 0 HOSE <br />p PJA SPARGE! OZONE t2 PUSH POrNr (t9P or OPT) GROUT SCAL PUMPED_ U Yee p No OTE: MA JMUM FRE111-11FALi- DEPTH IS 361) <br />,'SOIL SOMNG 0 HAND AtJGF_R GROUT SPECIFICATIONS1792r fA'/! <br />ll OTHER 11 OTHERAPPROX. GORING DEPTH W' &0S Ij DoL-M0 TRAFMC 9flX or G WrOVE PIPE <br />r CONDUCTOR CASING PRCPOmED—':e/- (Tr YES, list Apeclflcatlo" fi Comment goatlon) <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />43 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />I hereby cartify that I have prepared this applieaUen and tflat the work will be done iD .3ae.4rdanom with San Joaquin <br />Courity Ordinyncos,Pyles and F-Nulatlons, and all applicable California State Laws. <br />Slpned <br />Print N <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILF- ADDRESS: <br />WORK PLAN DATER: <br />q <br />A riCAtian Aoc d B (��L1� , _ _Are 'J PP � Y Ste ImCued � A <br />GMLIE Inspection ByOotB Final In�pecl;ar7 By Data <br />084 uC6on Inmpadon By UOats <br />COMM12N S / CONDITIONS: <br />ACCOUNTING ONLY-, A00 FAC,y I <br />PE CODES FeS�E INFO, APAOvFrT Rm6T3 FU CHECKS RECD 12Y j DATE lSesetl7C6 R <br />12( <br />G57_ WCC, -WAIVER_` C-57 LeTter of Authorization tc sign permit ooehrnent d4 <br />Kti� zq•o'-eat <br />g/30/2oas J <br />3 <br />4,,LJ CDT . <br />