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SU-2501014_SSCR
EnvironmentalHealth
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2600 - Land Use Program
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SU-2501014_SSCR
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Entry Properties
Last modified
2/5/2026 9:11:53 AM
Creation date
2/5/2026 9:08:03 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
File Section
COMPLIANCE INFO
FileName_PostFix
SSCR
RECORD_ID
SU-2501014
PE
2603 - SURFACE AND SUBSURFACE CONTAMINATION REPORT REVIEW
STREET_NUMBER
11510
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95242
APN
05507001
CURRENT_STATUS
In Review
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
11510 W STATE ROUTE 12 LODI 95242
Tags
EHD - Public
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1 1-14-202 12-27PM FROM CLARK WELL. INC. 2094625597 P. 1 <br /> P.01 <br /> i 1 14-202 12:95PM FROM CLARK Wel-tr, INCl- 209462&%7 P. 1 <br /> IRONI'I NTAL HEALTH DEPARTMENT <br /> SAN JOAQUIN COUNTY <br /> � �}- •y n115►Iperrirara <br /> beans K.Rook ILEZ S. 304 East Weber Avenot,Third'Floor Carl&mmw U.N.& <br /> .y Al ots �.Ii$ 5tackton,California 95202-27�3 �3ixa i#ures,k>i.:t.s.R t>i- <br /> Piognvn Afm,a�wrr 1'wyhr W.WzLq,n,A.l?.li.$. <br /> Fa tao Cos9ps,rtas. .s, Telmhow:(209)468-3420 IvMsrg*m <br /> Pmg-w M-9- Fait:(z09)464.0138 R4brA McClelhm.R.G.N.S- <br /> l�ia<k i3srctlFV,r,tt.8.H.5. <br /> APPLICATION <br /> DUTH OFWELL SEAL <br /> WAIVER <br /> WEj .ftimrlvtimam. <br /> Ti is application is made for a Waiver of the Mfulmum a=iar xpasc WELL 5r,AL DLtMl rogtlirW by <br /> —/�O 1Sit1 �l w�i sta arcs follow- ltscat><m: � �F <br /> Ih s Watrcc is re"vtw date to Inc fallowlagc rcumt3um. <br /> Thrs Waiver fs o pivnd based on tho follqwing: <br /> APj'It(vF0 DY: <br /> 0rtiz <br /> T11:1Mwing couditiotts are pkmed on the well construction permij and try not be rnodir, <br /> .. 7liC prop,cty Owtur aha}!Sit thu sppligtioa and naknov,'iv [gut the wet!CPDGM1i411 davijtcs from <br /> swwnum�fapth 4f wcl�Seal staadasda. <br /> . 2. 'i11c aonn3ar act�b trrrrtilmte in as'stapervios�taycr. • <br /> I. "is Wu fy t1,a ws1.r gr.l:ty f a d. w%.11,wd%u4.tA4W;W shaft ac=01yzen tar 14C 10�loWig ahcanuca4 Gf <br /> concern: <br /> I,Cite nndemlgmd awaer of the properly identified abowc;hereby rcclncat a Waiver I +et the <br /> tzset,ltnuttt rycll sraI depth staudards otsan.ivaquin Coastty bg$cd oft the inforn.atWo noted <br /> s�bovc. I asknowlWjc that this Waiver 4af0rma6n should be dlWoscd to subscgocnt <br /> er owbcrs. <br /> c. 3aG ,��tSaL aF exY Sr Ovitura . DJ17Ti <br /> F` �t1iY[Fl1ClAAt�i !'7d�f#1�e tt P[I■R"r1'r <br /> 1 01".SYATF,7.tP: <br /> S�ao,�r�s7 <br />
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