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03/15/2006 14:03 2094683433 EHD PAGE 03 <br /> 03115/2006 11:29 5365766005 STRATUS NO CALIF PAGE 02/02 <br /> . 03/15(2006 07:59 21594583433 pHD PAGE 02 <br /> WELL PERMIT APPODATION FORM WE <br /> .. =� ED SAN JOAClUIN COUNTY MITIGATION <br /> ENVIRONMENTAL HEALTH DEPARTMENT(EH D) UNIT LV <br /> I� 3 2D�6 304 E. Weber, Third Ftoort Stockton, CA,, 9 02 - <br /> (209) 4MS4 5 +— — <br /> �RogI� Mi N0DI&UN26FL-5 PERA111T0WRES 9 YEAR FRO DA2 tSS&R <br /> Kation l � y Caunt�ffar 2rrt+G f0 Ctandlgr Irs1!the vva�li dssC�£rt9d. T: appG�CloR i3 rtY#de I1t GOri1P1i�CL01°wii#i Stln <br /> Jeaquln C,put�r De�nelaprnertt Trac,CI1mtP#er`�91753 and th S49r+dards of Sin.loagtsitt bounty Enuaat�erRai Heatlf7 DeAar��L <br /> S�urai 1C ��� 'd0 5+a G-•.1=K � �, q; ltxK bio 'e pn�fi <br /> iAlBLL 4t�tion Cass Sum!! �.. 4'_,�.--i <br /> i 6 <br /> ,adze 4 kl �9 1}rwo, �`1� 3 <br /> G�'CarRrc4or nil; Ate' o Clty �rY�+„ p�+, �r��g51L.5 PhC� �r � � <br /> r.an.wItancrsubt ' rr, vs irxn .adr3a�C�Ps�t �l,. °rora � ` �t-ar, 3or .-d06 <br /> 00113 Caordr�ad K - •Y Township, ,w. ----Panic <br /> wo <br /> W WELL I ISC R[NG P-T.G ROW–HYOROPUNCH,HAND AdaM 0"M R"� �ESTR,UG'CZE3N (,�aose type below) <br /> I]WI1_ISCRING# OvER <br /> a[AKAE�'>:R <br /> �WML9 �l 1d� 1{PRESSUR9 GR0117 <br /> ar GROUT <br /> SPRaPICAMONS, <br /> WMMENT8- ! r�Llfr dr+ i 6rf" "� ' ; <br /> yy'.sOFiM>Eu INgr, 770AtTYP_E_ crib! T�4MSf? IFiiCAIIOL S <br /> ANG " H U.Ow mu DIA 09 B0R94nLE_%„•_, q RfiLll.`npL rCASII�C+S 1ulLfLTr•Lf=vEJ. wS1.L cP.sING D1A <br /> AMA <br /> WO Mff VMOW JJAIR I-AanMMDRSvI�N CASING-n4=MF s 77PI;4F CASING: D sTSEL )0 vc p OTHM <br /> U VAPOR 11 MUD ROTAR-C DEpTm OF GR0;JF 5EAL,_TR9WE TYPE TO BE USED: 1 AL)GERS II 0.1065 <br /> I]NR 3PARW OZONM ii PUSH PGIKM(Gr ar 0PT)C-A0L T8r=A1'PUMP>=D: Wes 3" (N lT :� MURK -FALL LD EM i!9 20') <br /> 0 ML DO12NG kMD AUGER C•ROUT SP91lr-fCA-n0 .nj <br /> u awpt _n dTHM APPROY,BORING DEPTH��7A;-._[1��R�FFIG 19Qx. '11STOVE PIPE <br /> S CONDUCTOR CA,SMG PRdposw 46 {3F"S,mst speacations In conlmert n) <br /> KOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEWMI Cl2 1fNGRGACHMF.NT PERMITS, <br /> 48 WORKING HOURS N07102 REQUIRM FOR INSPECTION$. <br /> I hereby Codify thatI have pmpared thjS application and that the work will be dc3e in v=ordanov with Sart Joaquin <br /> Cous,2ly O nq nr 3 d Regula4ons,and all applicable-California S Lj%ws. <br /> Sjgned x <br /> A-R Ttt+e�campa' co <br /> 3--�5-� <br /> PTIMNamA s4p <br /> TV NT USE—ONLY • <br /> SITE MAP IN UNIT IV FILE$AD KESS: 4- d <br /> ED; a <br /> WORK PLAX DAT <br /> �- „•,,, 8yy a,...r Date lssu�ri 3�i�.:l-c�- ��; a�re�._,.�..._..�.,^ <br /> 13rumspocilm By, Date FEnaf Impecdon 6y <br /> Cela . <br /> Oa�slellan Ifrsl?Of+�rs 8 � <br /> COMM>=TATS l WN1DMOUS; ' <br /> A=ttld t'1NG af4bo Alb# FAO <br /> PafjGPES Ft lMF4 AiYlol7flT RERII'ITSD CE�LGI£0 "CIE)BY up- PI=RMTr1 SfrO�flGE RE4GJF�# <br />