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Date <br />DATE PEEIRITISIIRVICE MUST XIJUIER <br />PAC'S AIDS A=UNTIME ORLY: <br />yob.- 11 <br />iFTE <br /> 734." I/323z <br />PE CODES INFO AMOUNT REMI = TTED 1 MACAU RECENED BY INVOICE <br />JAH-30-1996 14:41 FRO' --:NU I RONMENTAL ALID T INC TO 75123212094683433 F.04 <br />ENVIRONMENTAL HEALTH DIVISION <br />P 0 BCX 3EZ. 44E IL SAN JOACILIIN ST, STOCCOIL CA 52121412 <br />c203i U2-3420 <br />N0N4OFO1DAI1SPENWIT DCPtRES 1 YEAR FROM DATEISSUCt <br />ECiatOsts in Trigicits1 <br />Apptfcstion is hero by aede to the San Joaquin curry :Izr a permit to construct and/or install the work described. This 4PPLIcstion s <br />mope in compliance with San Joaquin County Development Tittn., Chapter 9-1115.3 and the Standards of San Joaquin Counry Fi.Lic esIth <br />services, Environmental Health Division. <br />5400 Pacific Avenue Stockton Jtt Address/or APRs City <br />kamtMont. Ward & Co., Inc. 14dmms1331 _Harbor Blvd., Fullerton, CA monet714 -773 -6227 <br />Czett riector Environmental Audit, Inc, Address1000-A atega Way., PlacRrytiaidi 60614R Phone 17121-E -37-RC21 <br /> <br />pi .L i ce, 706568 Phone * Caltratior TEG _ Aci*ts3 1130 Monier Park 916-853-8010 <br />Rancho Cordova, rA <br />TYPE OP wELLiPtimet ":`, ft'N LXLL 0 REPLACIXENT LTLL ACWITORIVG ALL 33 & 4 li OTHER Hydro Punch <br />0 DESTRUCTION 0 CUT-Of-SERVICE WELL 0 GEOPHYSICAL WELL a '0 SOIL BORING <br />7, INSTALLATION 0 1,e...1. snnlx REPAIR 0 CRoss-c-aXECT REPAIR 0 VAPOR.ENTRACTIGN ,ALL a <br /> Q Mem 0 Repair N.D. DEPT/ PUMP SET FT. FIRST WATER LEVEL <br />(TYPE OF PUMP) <br />errata V4k TYPE twynsi CONSTRUCTION SPEC:PC=0n <br />INDUSTRIAL 0 OPER IOTTCM DIA. OF 4ILL EXCAVATION DIA. OF CONDUCTOR CASIRC <br />OCMESTIC/PRPATE 'a.1 GRAVEL PACYJSIZE TYPE OF CASING/STEEL/PVC DIA. OF WELL CASING <br />WaBLIC/MUNICIPAL 0 DRIVER DEPTH OF GMT SEAL • SPECIFICATION <br />0 IRRIGATION 0 OMER /AG GACUT SEAL INSTALLED 87 CROUT BRAND NAME <br />SI MONITORING cActrr SEAL PUMPED: L.: Yes 0 No =CRETE PEDESTAL ITC:RULER: 0 Yes C )10 <br />APPIOX.DEFTN 50 =ZING CHESTER ION/STOVE PIPE <br />PROPOSED CONSTRUCTIONIDRUIJR4 MITHOD: MUD 207127 AIR ROTARY AUGER CAaLE OTHER Hydro Punch <br />I hereby cerviTy that I have prepared this apottration ant that the work wilt be done in accordance wlth San Joaquin County Ordiranc-, <br />Stste Laws, and Rules end Regulations of the San :oscuirs County. Rome owner or licensed agent's signature certifies the followirg: "I <br />certify that in the Performance of the wort for ialich this permit is issued, I shalt not employ persons sLioject:to*WORKMAW'S C:DePW.AT1ON: <br />Laws of California." Contractor's hiring or v.-a-contracting signature certifies the following: • certify that in the perfortnnce <br />oi the 1:crk for vhich this permit is issued. I shalt empley persons subject to =IRAN'S CDOERSATION Laws of California.' TA! APPUC•a7 . <br />MUST CALI.24 IX ADVANCE Peirlietbun umptcnoxs IT an VA-2423. Cooplate drawing at lower area provided. <br />14 <br />Parcel Siza/APwa <br />Signed X Brent Mecham fl t teSenior Project GeoloqlstDate30-9 <br /> <br />H <br />I <br /> <br />t <br />I I <br /> <br />1 [ <br /> <br />'2/2'5 04 <br />DEPARTMETT USE ONLY <br />Application ACcePted 3)' <br />Grout Inspection 8y Date Pump Inspection ay <br />Destruction Inspection By tate Comments: <br />4.- tw, • • .1., ••••••