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SEE SITE M NIT IV WORK PLAN DATED: <br />DEPARTMENT us& ONLY <br /> Date lasted <br />Dor <br />Date <br />COMMENTS / CON DrTtio NS. <br />/— zcx.)c) Appecetion A•zooted By <br />clehot Inapection By <br />0.4.1,uctign Increciton ay <br />Dec-22-99 03:18P Kvilnaug Drilling <br />925 686 6678 P.06 <br />4k9 <br />• <br />WELL PERMIT APPLICATION FORM UNIT IV <br />• <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) <br />304 E. Weber, Third Floor, Stockton, CA., 95202 <br />(209) 468-3449 <br />ORIGINAL <br />NON-REFUNDABLE PERMIT IESPIRE51 YEAR FROM DATE itliSUED <br />AppLcenon 's hereby made to Sr Joaduin County tOr a permit to conatruct andtair Install :he work described Ttils appecation .a mai* tn comiar Li viol <br />5all <br /> <br />Jo on Ccarry Development /Me Chapter -1 1153 a the Standards of San Joaquin County PLO,t Health Services, Env ronmentai 0-reann Uvistrin <br />WELL Looeslon -IS (-4-1, VALP 1 co Rb Cram &twat 7. \ 53 7.6 -TRACq Staity .-TRA CY <br />Aqsessor-, <br />Zkr <br />PROPERTY 0.me ALA snc5 Abdr•ris i zo 1 E Ceti rTZS A ve city 041414t141M Zip/7-8D 5 phvioloi,,,105f.7.5. z-- r Rt‘ tt <br />C.57 Contract KNAlii ft t.1 & mai-ask/id 5" Lilit140;AI a'44/ city lnircrea zpeiciczaics_Yolm•onost ..751' 6 Ss-c6 e13 <br />Consultant ; S rb Conlia clor (lit A•96..PC. Acdress /3..r6 /My/ sr cry 814)(ajoik 0-A-Ftlore,_ 747 _.7tif....7 74sill <br />GIS Coordinates X <br /> <br /> Township Range <br /> <br />WORK TO SE PERFORMED <br />1 NEW utki BONING k CPT GEOPROBE, HYDROPUNCH HANNAUGER OTHER') <br />SPOIL BORING it <br />WELL* <br />-Other <br />.?.:11iiiii . .0.7.F i of : I il•WITIFTJA! i r."XiXL.." <br />['HOLLOW STEM DIA OF BOREHOLE 2. pp,Rfigti c'Aeir;i6g4 ((lir, No WELL LASING LIA <br />U AIR HAMMER/ORIVEN CASINO THICKNESS ."-----. TYPE Of CASING. a STEEL 0:/VC. a CThEe ------= -_ <br />TREMIE TYPE TO SE USER 0 AUGE9S nmosP. ['MUD ROTARY DEPTH OP ORCXJT BEAL 2- .). <br />OPusH PtANT GROUT SEAL PUMPED: Oyes I No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />U HAN) AUGER APPROX. BORING DEPTm 2,5-' a BOLTED 'TRAFFIC BOX or 13 STOVE PIPE <br />a OTHER CONOUCTOR CASING PROPOSED? At 0 i it YE *, ,181 Bpsegicariont here! <br />s.ba.on <br />DEC 3 1 1999 <br />U DESTRUCTION kehooss type bel3w. <br />OVER•BORE <br />fl PRESSuRE OROLJ <br />COMMENTS <br />OF WELL <br />0mONITORIND <br />o EXTRACTION <br />VAPOR <br />11 AR SPARCE <br />11501,- BORING <br />Ocn-IER <br /> <br />COMMENTS: <br /> <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS <br />inerrony ,marny met I hihdA prorated this application and that ate work will be date In accordance wnth San Jtsichtir County OrdirtarCe3 State L10111, ard no Rap Sat Jesq_mr+ Chu* Narheawner or licensed agent's signature certakos the fotowing ? carfify that in MS parforrnanco of tp• twor• <br />for which this parrnif ts issued, I shall not employ persona subjaet to WORKERS' COMPEAisATFON Lows of California." Com/we r A hiring cr BUD <br />contracting %langur& certifies the following: carfrfy that in the performance of the uork tot wh'eI thIs parrno1w matisel, r thee st/7pkypersoo.4 aupfect <br />WORKERS' COMPENSATION Lew of California." <br />4010SION400.44T 005111441011WREENtiePfieria148 . <br />Alee_f-3 Dat• <br />I ACCOUNTING ONLY: Althri <br />FAQ* <br />I PE CODES FEB INFO AMOUNT REMITTED CHECKS 1 REO'D EY DATE • <br />----7 <br />i.EOUEST a NVOICE <br />--- <br />I <br /> _...., <br />tiEcT.ARATIoN <br />UNIT IV - 6/23/99 /sign bitegOAT <br />viar Nd00:E <br />THE <br />si t