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CONSTRUCTION SPECIFICATIONS <br />DIA. OF BOREHOLE MULTIPLE CASINGS g MULTI-LEVEL WELL CASING DIA: <br />CASING THICKNESS TYPE OF CASING: a STEEL PVC a OTHER: <br />DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: 0 AUGERS a HOSE <br />No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />TYPE OF WELL INSTALLATION TYPE <br />if -MONITORING p HOLLOW STEM <br />13 EXTRACTION a AIR HAMMER/DRIVEN <br />1:1 VAPOR U MUD ROTARY <br />IJ AIR SPARGE/ OZONE g PUSH POINT (GP Of CPT)GROUT SEAL PUMPED: 0 Yes <br />SITE MAP IN UNIT IV FILE, ADDRESS: <br />WORK PLAN DATED: <br />Application Accepted By <br />Grout Inspection By Date Final Inspection By <br />Date Issued <br />SITE <br />VI... <br />.: (209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd1 , 2005 UNIT IV <br />Well Permit Application En ,!.7,nknip: w -1E-.ALT <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with San <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> <br />. \ ( , Assessors WELL Location '\.TtlA t-; MA' \r,-- t0I' :1 Cross Street City 40e ik---td) Zip Parcel* ccak - CoLAc St-e-t-\ <br />: — MITIGATION <br />n Environmental Health Department u, <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 <br />San Joaquin County <br />PROPERTY , <br />Owner '\ ( \ U4k- ---tCt \lOcCO,Address <br />C-57 Contractor (1)(tOSC:-.),1 \\ \ \t Address Sc(A.i )-1.Ck,ra, laC,1 City "a' Al (AC Z.Zip ' i LV,35 LIG* Li Q;_i il`;) Phone* (CiJS) 31 3 - 5% Cc <br />Consultant / Sub Cn tCt) tr ileei CcA I V -I ) ) Address 1101 --itl - C -1 itY \i\kk3-OA-7c1-ic# --- Phone* <br />GIS Coordinates: X , Y Township Range Section <br />WORK TO BE PERFORMED: <br />0 NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER) jappTRUCTION (choose type below) <br />a SOIL BORING # 'MI:OVER-BORE. DIAMETER O WELL # (3 PRESSURE GROUT <br />O *Other GROUT SPECIFICATIONS <br />COMMENTS: <br /> City c:A 01Xlzip Phone* <br />Ii SOIL BORING a HAND AUGER GROUT SPECIFICATIONS <br />a OTHER: OTHER APPROX. BORING DEPTH a BOLTED TRAFFIC BOX or El STOVE PIPE <br />CONDUCTOR CASING PROPOSED (if YES, list specifications in comment section) <br />COMMENTS: CXL lk( ,Ur Th <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />ulations, and all applicable California State Laws. <br /> Title/Compa /270/1yeSe. i‘rert ia(176;10, <br />Date <br />DEPARTMENT USE ONLY <br />Destruction Inspection By <br />COMMENTS / CONDITIONS: - c&c <br />Date <br />ACCOUNTING ONLY: AID* FAC* At60 <br /> <br />PE CODES FEE INFO AMOUNT REMITTED CHECK* <br />35 0 L i . , 1 I <br />R, CD BY DAT/ PERMIT / SERVICE REQUEST # INVOICE <br />t <br />/ ( ilk S R# <br />C-57 WC -WAIVER <br />EHD 29-02-001 <br />6/22/04 <br /> <br />C-57 Letter of Autho VtiOn o sign permit ech ent <br />6R C( ‘1e)-," <br />oc _ <br /> <br />County Ord' ce <br />Signed x <br />Print Name (./' tanec