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11/20/2000 16: 48 19166385611 <br />CASCADE DRILLING INC <br />PAGE 03 <br />'ORIGINAL <br />WELL PERMIT APPLICATION FORM <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) <br />304 E. Weber, Third Floor, Stockton, CA, 95202 <br />(209) 488-3449 <br />Namtragootauumnavr EXPIREI1 VIM 17011 Mil POSIA1 AppPosition Is nreby reads to Son Joaquin CJourrty for pannit corielnnt Mitt Instell tie letalc Claserfbad, This apploatlon is nude In coastlines sett Sin <br />WELL Location <br />Joequkt County DrelopmentTltir,oppler 9-1113.3 and stnendtmle of Sin Joaquin Count/ Publk SeMees, Environmental Mesa DtvesIon. <br />PROPERTY Owner . <br />CAI7 n trJctc11,,ke <br />Consultant I Sub Ccntractor TT Orr?Address' Pa • 44Canr:&11144 Usi Phoneil-2 ) <br />Y Tcvmstilit Ram" Sectiok. <br />SITE <br />MITIGATION <br />UNIT IV <br />ku-'? <br />) <br />(T <br />g pd-/C9s- 471165ç6g. crus, gee Lou tst_ Av6y zip C1S-330 perAa.orr* <br />0 67 Acioregal (115 ii0VNJO IL 120% &trbeciP 471• 9 5...3 -ewe, zszio 00 <br />Addfts4057 On-xj C t zt.isatzsk VIV001122244ir <br />9Ar <br />Coordlratet; X <br />,WpRIc TO DE PORFORMED; <br />'pew WELL I BORING (on, GEoPROSE, HYDROPLIN011. HAND-AUDER. OTHER" <br />M AOR640 <br />WdEll CI *Other: <br />COMMENTS: <br />0 011/111RUCTION•ichooestçs13•10.4 <br />a OV131440RE <br />PRESSURE 021ROUT <br />Omit Saecillitattionsf <br />TVE OF WELL <br />i <br />214rytiAllatilrin <br /> <br />V...714fT0FtING LOW tried <br /> <br />D EXTRACTION LI AIR 144.0.16/4/1)RIVEN <br /> <br />[j VAPOR N MJO TAY <br /> <br />,NiFf SPARGE a PUSH POINT <br /> <br />Q SOIL BORING fi HAND AUGER <br />a <br /> <br />OflR jDTl4ER <br /> littifenOSS <br />OLA OF ISOIRENOLE )5": " MULTIPLE CAS/N037 D YE* )410 WEIL CAIMPKI PIN C9. I% <br />CASING THICKNES.5 SCA" IA TYPE OP CAII4N0c 5Tett V1 UOTHEN <br />DEPTH OP GROUT sex. ca memo rwae to as useot Daus/as 13 i•icew <br />amour sEAL P UPAPED: Yit 1/40 (NOTE: MAXIMUM FREE-FALL DEPTH IS 301 <br />GROUT SPECIFICATIONS' <br />APPROX BORIND DEPTH 6781- 'PG" jiP4OL1110 TRAFFIC SOX if 0 STOVE PIPE <br />CONDUCTOR CARING PROPOSED? NO I If YEA, SO speceScallone testsk <br />-DOMmeNTs: <br /> <br />NOTE; OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br />CALL THE UNIT IV INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. <br />I hereby certify that I have prepared this application and that tna wont will bs dons In accordanc• with San Joaquin <br />dins tilos and Regulations, end all applicable Calkotnia State Laws. <br />grf' /// rty Tbeicempony (), /111 _C.,,i;L.cr a <br /> Dat1 /41(._ <br />19PEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS: R.0 -4-1 7 _CAry, tse, ogo <br />WORK PLAN DATED: V\ <br />lioptioatton Accepted P3,,f 'two olle • Dais leated / I • J }III <br />,45" <br />41,16"1/ 3rout Inspection Sy Agar. Real Impaction ery <br />Aran.102Aon Inspection ft / Data 11Mill <br />:OMMENTS / C ON WOKS. 4 <br /> <br />ACCOUNTNO ONLY: <br />--- <br />AL* I Fleil <br />PE CODES PEE INFO AMOUNT RAMITMD CHECK $ REVD ST DATE <br />-7"'"-- <br />MAW I aldirvicilrfeee nvoice <br />Ltik:' <br />/ q;,- --7 /7/far - ,_ out c 9 6,9 171. 3 . _ ...._ _ <br />C-57 WC -WAIVER C-57 Letter of Authorization to sign permit EnoroocPnant doc___