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i <br />1 I <br />Sispled X <br />1 <br />1 1 <br />111111_ 11 <br />//3016, Are. 6g)C7 <br />Date <br />56e.40-k <br />* " , LETED <br />3r>i <br />JAN-7P-1996 14:42 FROM ENVIRONMENTAL AUDIT, INC TO 977551232120946E3433 P.05 <br />ENVIRONMENTAL HEALTH DIVISION <br />P 0 ROX 3. 44S IL, SAN JOAO= ST„ STOCKTON, CA S62111-.1e3 <br />BON.REFUSDABL! PERMIT MIRES 1 YEAR FROM DATEISSVE1 <br />20S) 4%3420 <br /> <br />ORIGINAL <br />ICeemplete eTripDammil <br />Application is here by made to the San Joaquin County for a permit to construct and/or install the wort described. This application is <br />made in compliance with San Joacurin County Development Tit. chapter 9-1115.3 and the standard* of San Joaquin County Public Health <br />Services, Environmental Health Division. <br />Jeb Addross/or APRs 5400 Pacific Avenue citvStockton Parcel Site/APU0 2 <br />GUNK'S liafte Mont. Ward & Co.. Inc. .Lddress 1 3,31 S. Uarbor_Blvd—,Fullerton CA. Phone 1714-773-6227 <br />cwitrecter Environmental Audit. Inc Acir:rsts 100_0—A Crtega _Paxgriblas 606348 Phone *7 4-63 2— a 521 <br />Pack P1. Rarrin Lia phone 4916-853-8010 <br />Ccrig426 CA <br />ITRE OF WELL/1'4,401 REV ...ELL C REPLA.VENT VELL MONITCRIRG WELL 0 1 & 2 07HEZ Hydro Punch <br />DESTRucl IGO 0 CUT-OP-SERVICE 'ZELL 0 GEOPeSICAL WELL a •C SOIL BORING <br />7; INSTALLATION 0 LELL SYSTEM REPAIR C CROSS-CCRUICT REPAIR VAPOR.EMACTION Vt..... 1 <br />0 Rau C Repair X.P. DEPTH rum) sr FT. FIRST WATER LEVEL <br />(TYPE OF PUMP) <br />St t COntraCtOrTEX; <br />USE TYPE OF 'MU CONSTRUCTIOR SPECIFICATIONS <br /> <br />OPEN BOTTCM OA. OF WELL EXCAVATION DIA. OF CONDUCTOR CASIRS <br />WAAL PACK/SIZE TYPE OF CASING/STEEL/PVC DEA. OF WELL CASIWG <br />DRIVEN DEPTH OF GROUT SEAL <br /> SPEC:FICATICN <br />CTNER GRCUT SEA/ INSTALLED BY GRCUT BRAND BANE <br />GMT SEAL ?WED: L. Yes 0 So <br />LOCXING CHESTER SOX/STOVE PIPE <br />HUD ROTARY AIR ROTARY AUGZR CABLE cTE ,ydro Punch <br />I nertty cortily tnat I have prepered this acct.:cation and that the wort will be done in accordance with San Joaquin County Crtirances,' <br />St5tt Laws, and Rules and Regulations of the San Joaquin County. Nome owner or licensed agent': signature certifies the following: mI <br />eerti .fy that in the perionftanct of the York iorwhich this permit is issued, I shalt not employ persons suioject:to'UORKMAR'S CCMPSNSATION: <br />Linn of California." Contractor's hiring or c•Pr-contracting signature certifies the following: m I certify that in the perl'orsence <br />oi the wcrk for which this permit is issuad, ! at1 employ persons subject to =XMAS'S COMPENSATICW Laws of California." THEAP911C.IXT <br />MUST CAUL2 DRsAN ADVAACEN4rOMMIT ULSPECTIONS AT 0.0SI4$1-31,23. Complete drawing at tower .erea prveided. <br />Brent H . Me chank- genior Project GeolcgistD.t. 1-30-96 <br />1. <br />DEPANTIKENT USE OVLY <br />Appllcation Accepted ay Date <br />Grout Inspection 3y Date Puma Inspect on By <br />Destruction Inspection ay Date Comments: <br />A=UXT014 oNLY: <br /> Al D% <br /> FAC* <br />PE CODES FEE 100 AMOukl MAITTED 1 CRECESMASH RECEIVED BY DATE peva-num* REOUEST UMBER i MNOICE <br />' 3501 , 5 Es 356. " 1 /3132- l-t-i //1/7(0 5:entOo g.318V <br />I <br />I ---CRar a -.3,.(,' 1 <br />• • ••••••••••••••• • • y <br />TOTAL P.05 <br />IRDUSTRIAL <br />DomEsTIcipluvATE <br />C PosL/C/WwICIPAL 0 <br />IRRIGATION/AG <br />MONITORING <br />IPPROX.DEPTS <br />PROPOSED COUSTRUCTIOIMMLUNG WITHOO: <br />50 <br />CZNCGETE PEDESTAL BY DRILLER: C Yes C No <br />co-4