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04/27/04 17:41 $1 510 521 5078 HETI-ALAMEDA 0002/003 <br />Ba/97}2804 13:86 289, J433 FIFTH FLOORI�1]5 ECS PAGE 22 <br />Sari Joaquin County MAY 2 0_ 2004 <br />Environmental Health Department AkITI - <br />300 est Wober Avenue, 3rd Floor, SWC11= 1. u 95202 E.WRUINM E BION <br />p�RMITI� <br />(209) 451.3449 Fsx. (209) 468-3433 Wob: wwwxassaojawpjKLr.a us/eh UNIT IV <br />DABL1 MWIRIM f YEAR FRcN OATfi ISSUFO <br />APPMW► IN hN" Made to Son ic"gin Count? Mr Q permit to eonl jw* andlaf 'inslall the work derma, TWA 4PPPrv=Qcn is made In c"pMwM vft Ser, <br />4MKPI^ 0e+d DWAMPM01t Title, cNq*& i`1113,3 and ra f mdrrtis of San J1000n C -90y EnrIRMIR &W Hsafrff Depwwrenr. <br />WELL LA�r:n �YD 144, LA a< Etre ci �aarow ~ d u <br />OSI 22 6N to • Addm"22� W-wA 1 1sfbJ1v 1 ,$.tE. pnonaR ' (o—(p9Z,�' <br />e.67 r�rraler�� Aedhrs�i'N101n1oXi clg�p+P14Fb a,e�e3 -85 3-$a ( o <br />Gls <br />tam To 112 <br />I MEW WELL / �ORINM ,�T GEOPRoeE, HTLIRQPt1NGi. HANICAXER OTNgn Q DESTRUCTION (�ooeo type ems+} <br />AQWI WELL <br />I110R m B <br />I(>OR DWME7EfL _ <br />310!l+en L 4,pOROtRIRESSURE GROUT <br />8i"ECIf%fG►TIOt�IS <br />Gol4AwE!(Ts <br />E CQFISTRUGTON AM;IFICAT1ONer- <br />Q MONVaRm 9 HOLLOW STEN DtA Op 13rJRJ;gM01, <br />f;r, Q 61ULTlFlE CASING6 O MULi1LE11H_ WELL C6BlN9 plA: <br />0 ErTRAC=ION 0 AJR KAMIMEF1?vf IVSN CA,SIWTN1CI04RM I TM OFCASINO: 13 SML <br />Q PSC it QTFERDVnPOR 0 MUD ROTARY DEPTH OF QMUT TRpIIE ^,ice <br />Tft•E TO BE USED p �uoeRs a HoSp <br />a AIR SPARGEF OZONE "M POINT 03P or C1sT)GROt1rSEAL PUMPED: Q Ys p No (NOTi, MAXIMIJM FREE -FALL DEPTH IS 30') <br />OIC BOFBNQ a "Aho AUGER GROUT SPECJFlcs,Tlw <br />OTWFZ 11 APPROX RORWAr. DEPrH jl 1301,7® 7R8FFIC BOA or 0 STonrfr PIPE <br />n �p eoNpUCTop _NEi a j1f TF9, ist apeahleilfefle fn ralnmcnt atdon) <br />COMMENTS- 11 PAT -OV AAInIA, K .�-,l — AT '70-r <br />NOTE: OFFSITE BOPJNGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />48 WORKING MOURS NOTICE REQUIRED FOR INSpEOTON& <br />hereby eer" um! I have ONparsd this applies1 an and that the work be doge in accordance with San Jema W n <br />Cvltt�l , Rulas �d ulations, and all appGeable Csllferrtla St�ala Lswm. <br />Print Nw,� _ ►►�T1o�- <br />DEPARTMENT USE ONLY <br />SITE MAP iN UNIT IV I <br />WORK RAN DATED: <br />AppkA m Aaepled tar <br />GRer+R Mupe�C+rl MY.8 <br />QJIe 1 F61a1e !I Da1r <br />D OCUetlorl ImMecUun sr a� <br />co"EMTS! CONDITIONS- <br />ACCOLIMTING ONLT. I AID* <br />PL' 020SO ' rez rNFO I Amou NT mmirrED I CHEM* I RCe�Q frr DAT@ <br />S <br />5 <br />PM f, Y SERV C9 Ft&WL5T 1 INIW"CE <br />3soI cq.oc) 336Z s2,o Ser# 2 g!/ S <br />C -S7 WG` WAxYER_ C-57 Letter of Autheri2a isn to sign ernlit <br />7e9a�Qo1 g p . Eneroarhmenr dec <br />Maa_ <br />S(�Oo`3�i�5 <br />