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JUL-23-2307 16:3© FROM:MWH GLOBAL 916 418 8522 T0:209 464 8059 P.2 <br />V , , L,, LVuI 13V41 i1. 67 1- 1V7v..4vI4 -, ­- y"vv ­ <br />r San Joaquin County <br />z Environmental Health /Department <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 <br />(209) 468-3449 Fax' (209) 468-3433 Web: www.sigov.org/ehd <br />L F©' Well Permit Application <br />SITE <br />MITIGATION <br />UNIT IV <br />4ON-REFUNOA13LE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described This application is made in compliance with San <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards cf San Joagsan County Environmental Health Department. <br />Aasessors <br />WELLLcicadars 1350 A.I. Swg&j;, q#6C. Cross Street MYrLE City S71t&1VJ%J Zip 5x15 Parcel# t5'9p2g10 <br />PROPERTY <br />Owner M; JC��Addrocs 2 �0) AL 51M,04,'r City ! .R Zip%al/, Phong#1 2 * '4r -�Z r- a 2- <br />C-57 Conireotorg=7 0,� Address ILZ0 A;• Se'rr S7: Cilyb%41wn4 <br />ILrw i wJ ad . <br />Consultant I Sub Cntr :cj" i Address 332! E� City ^.-Licffi Phone# iFi�� ��3SSf <br />G15 Coordinates. X �3•�14 sem• °� r , Y 1751 a S, 9S Township Range Section <br />WORK TO ee PERFORMED: <br />EW WELL I BORING CPT OPROB , HYDROPUNCH, HAND -AUGER, OTHER') -$DESTRUCTION (choose type Below) <br />0011. BORING # Q OVER -BORE. DIAMETER <br />Q WELL A ARESSURE GROUT <br />Q 'dorm+ GROUT SPECIFIC! Tlnrlc <br />C0141MENTS: —�— <br />TYPE OF WELL IISAl11X01jON TYPE CONSTRUCTION SPECIFICATIONS <br />MONITORING Q HOLLOW STEM DIA OF BOREHOLE) Q MULTIPLE CASINGS a MULTI-LEVEL WELL CASING DIA: A44 <br />Q EXTRACTION 0 AIR HAMMER/ORIVEN CASING THICKNESS .*J*4 TYPE OF CASING: u STEEL Q PVC Qtv _QTHER: A-44 <br />0 VAPOR Q MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED. X Q HOSE <br />Q AIR SPARGEi OZONE ;VUSH POINT (G? or C PT)GROUT SEAL PLMPEC: 0 Yes D NO (NOTE, MAXIMUM FREE -FALL DEPTH IS 301) <br />OIL BORING C HAND AUGER GROUT SPECIFICATIONS��w'�J� ' �•e+.'i�' C�.3t` <br />Q OTHER: IQ OTHER APPROX. BORING DEPTH Sr' a 13OLTED TRAFFIC BOX or 0 STOVE PIPE <br />CONDUCTOR CASING PROPOSED (if 1'E3, list specil3catie�,5 in sommant Sec.",e; <br />COMMENTS; S*a L ��.��� �� g � � x.44.4 f..- � •i �.�a �1 �r S3'� ��� � <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS, <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTION$, <br />I hereby certi9yy that I have prepared this application and that the work /still be dale in accordance with San Joaquin <br />County Ordinances, Rules and Regulations, and all applicable California Slate Laws, <br />Slgnrd <br />Print <br />SITE MAP IN UNIT IV FILE, ADDRESS' <br />WORK PLAN DATED: — <br />Application Accepted <br />Gmul Inapecdion By_ <br />Title/Company Ob Z,* wq A%iiiiretw.30 Zyc- <br />_Cate � �Z Vq iL <br />DEPARTMENT USE ONIY �� <br />DesirWion Inspgction By Date <br />COMMENTS I CONDITIONS: <br />Fina! inspeclicn By <br />ACCOUN71NG ONLY. AID# <br />FAQ <br />I <br />PE COOtES <br />FEE INFO <br />AMOUNT REMITTED CHECK $ <br />RECD 8Y DATE INV O11 CE <br />1 <br />N� <br />�RI� <br />C-57, INC_ -WAIVER_ C-57 tetter of Authorization to sign permit,, ^ hment riot <br />FRD 29.02.001 <br />6!22X04 <br />C, <br />