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! : <br />.• <br />1 • <br />t: <br />ACCOUNTING C t4L14- MOP . <br />FEL Ammo' nErAinrc <br />_ C-57 WC._,-WAIVE It C-57 Letter of Authorization to sigh per <br />- <br />"Fi-v-146"tet-Flroti—eg-T--volcE. <br />SRb <br />VEnc rode kment doc • 9/27/01 <br />PE CODES 1.14 FO C HE DX REVD BY <br />af47 <br />FAr, <br />DATE <br />AUG 26 2002 4:35PM HP LASERJET 3200 <br />09/26/2002 16:10 2094683433 <br />RUG 26 2002 El: 51AM HP LASERJET 3200 <br /> <br />P • 1 <br />FI7TH FLDOR <br /> <br /> <br />c-rIvINOMIDITAL, I-GAL ga <br />PAGE el <br />WELL PERMIT APPLICATION FORM <br />SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br />ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) <br />304 E, %ober, Third Floor, Stoolcton, CA., 95202 <br />(209) 468.3449 <br />Nortzittegri DAM POW IOCEIM 1 YEAKPAOM 9A01*SUL12 ROMS*I haasfay made lo Sin Joaquin CounV for a parinS le conalniel one* Ins TN* applea Is ,!II ih tarepOwle stfrh Son ASIA1 Cow* INANIMPonh1:104. Chao Isr .1115.3 'nettle Standords of San Asegnin Court. RAISc KMAII Strew, EtIvitommIll <br />141180' OP411"1 . <br />d4lialb•st llon o <br />ELL UN Woo <br />Cocas Stoael,ffol <br />SOPERTY Chew <br />. City Zdooff 2ip <br />Adons4I POO <br />Assenbes <br />0Or .r-torrIo‘ CORGIS R46111402, ;30 ?AV.? Phonob(4ASiZel:1 -47004 47 Conics*, • .01 kiEr tilat4" <br />omits,* / Sub Cent' Ai <br />115 <br />efA Mohr Rt4 kastratiaLicpmzicsivsnee <br />(*Nowa& , Township Sed1/4111 <br />SITE <br />MMGATION <br />UNIT IV <br />"Offisr., <br />COMMENTS: <br />NORICTO SE rgeroKkIeol I mew vim/ PORING (CPT. GIOPROSc,WM:WRACK HAN AUGER. OTHER) -NarsoiL eortiNo r 6 <br />0 WELL • <br />Oscan Spnetcations • <br />0 DESTRUCTION (acos' fop* below) <br />oves-BoRe <br />C PRESSURE Wow <br />pgrALIATIOrrilPa <br />' 0 1-10u.Ow STEM <br />-*At AIR HAMME;VORIVEN <br />0 MUI? ROTARY <br />Dion*/ PORT <br />CONSXM0710111st ECIPArt1014 <br />blat. P OCKEHOLE MULTPLEcAsiNGSr yes [1 NO WELL CASING 010441 CASINO THICKNESS TYPe OP CASING: 0 S'TEEL OPVC 0 OTHER <br />DEPTH OP GROUT SEAL IRE/4E TYPE TO BE USED: 0 AUCER fl HOSE GROUT SEAS. PUMPED: 0 INOTE: MAXIMUM FREE-FALL DEPTH IS 3011 <br /> -\10TwERCEnfLestidrePPRO WIL X, soma DEPTH iS` 0 'TED TRAFFIC PON or a STOVE PIPE <br />112Layitu, <br />mONITORING <br />0 EXTRACTION <br />0 VAPOR <br />BAIR SPAPIGE <br />C SOIL BORING <br />D OTHER; <br />COminerfra <br />HAND AUOER GROUT SPECJFICATIONS; A/fit <br />.-L CONDUCTOR NI CASINO POPO 0? III YES. Sal spacifloallorta *Matey... <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 />(71,S <br />I hereby cortlf <br />itmilaw <br />County Ordi Is application and that Wm work will bo done In accordance will, Son Joaquin antis, and all spill feablo California Stall, Lows. <br /> ThigrAmpantaeterC Lel kki-Va <br />pthooma CffitirrOPM frefillIZA Doc PizZA2- oVPARTME10 USE ONLY <br />sITE MAP IN UNIT FILE, AD RES /0. 6-; /P1` '7.4_; <br />WORK PLAN DATED: <br />Popaestl on Accepted by ' <br />Crawl Insprenes by <br />bearvelon Inspfxsonik., <br />COMMENTS I CONDITIONS! <br />Dile <br />0.sle cl >(1, <br />Final hanation by Dais .!—Cs <br />Doll <br /> <br />,2 31) -0302_