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03/15/2006 14:03 2094683433 EHD PAGE 02 <br /> 03/15/2066 11:29 5306766005 MATLIS NO CALIF PAGE 02/02 <br /> - 0311W2006 07:55 2054683438 EHD PAGE 02 <br /> . WELL PERMIT APPLICATION FOS! <br /> SAN JQAQUIN COUNTY MITIGATION <br /> ENMRONIUIENTAL HEALTH DEPARTMENT(EHD1 <br /> UNIT XV <br /> #1kAp 304 E. Weber, Third Floor,Stockton, E.A., 95202 <br /> (209) 499-3449 <br /> V1R041 6 + -Ti n"4:t vhmAs gPurr r�aFs v R FRM DAT13 <br /> AppII�Dn��` quln CauaLy fir+I iit t4 mra 11 z aIdlar 1nsM the wo**soillW• This OoPffeat on ig Ih oOmpGxltee mth San <br /> Joa4�n Dotn'Ity E7eveloprtlen4 TEIE�,CI'lapter�-'t i X5.3 and Standards�Sen JoagtbR�4!Enuirorarr�erstsl H�1�Dep�rtrr�ent <br /> v+r Lts on ode, i I� 1 so �--xps z.a`I vis <br /> PROPEt2 <br /> 'rY t �M� w, A.,c y. 5 6,k 6^ �'ip LPhnne# <br /> G5�'t�noador i.1G� A�dr e. D„ yg �, _ Chy Rr�tn �p I�Uc94 fk5 pt=.e9125t3r3- vL _ <br /> rer►sutt'S1rltls�If� ' ta�uS ire., .�ddr�ss ©�stvlrt�tnl�tlf�+.i��G�+,,��x�+�•�'�#�� $Z _Pt,«,e#S��(r��-�,GZ <br /> 9115�'X _.Y To1MR5tup R2riyL ' <br /> w9mL 4E QED EQ <br /> Q NEW WELL t BORING (Wt.GE0PWW—HYDROPUNCK t M0,A►i M OTHEIr) STRL,4=ON (emme type below) <br /> 0 SOIL BORING 0 ovE. <br /> otAha� . <br /> W. E-L ©PRESS!!RE GRGITI' <br /> ©. GROUT <br /> SPEGIMCATM <br /> r <br /> nT1L <br /> CWr LL 7N 7tO E CSN !) OR 5P IRICATI15[+IS <br /> TOR1NG XIIOLL15W STEM DtRL G1F BOR�t _ q i41UL71WLt;CASINGS M MULIII-LM _ WM.L CASLNG€A: <br /> OF_XTRACTM flAIRHAhAIUIERfMVW CA51NG-rKCXNEW Type ofCASNr: 0STEER gFVr, DaMER:� <br /> q'UAPOR D MUD ROTARY DEPTH OF GROUT SEAL TREM IF TypF To BE USED: ,6 ER-S Q DOSE <br /> !I!AIR spAROW=rjr= a?USH PorKT(Ga or CFT)GRQUT85ALPCCC PW; Wm 0 na (NOTE:Waamum -FALL DEPTH M 30.1tiSClf BORING d H"AUGER RbtJTSPE ICAnonts 2�ab+, - yr <br /> (�O'1'FLER',,,�.� A OTHER_ HPPROR.SWUNG DEPTH ,��[1 BOLTED TRgPFIC E3OX. �fl STU%vF.PEPS <br /> CONDUCTOFZ CASING PROPOSED 40 [If yEq,Est spe[ff=bGM h=n=At*0 <br /> c oom em: 6+1 ] - wI E S <br /> NOTE: OFFSITE BORING$ REQUIRE ACCESS AGM E oR ENCPnACHMENT PgRM TS, <br /> AS WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS- <br /> I hereby gerkiiy that I have preparad fts appFication artd that the Work will be clone in ac4raidance with San Joaquin <br /> County Ordinm Regu[atiom, and all applicable Cardamia State Laws. <br /> Sigrtzd x <br /> 5 5ibL <br /> Flim m s -`� <br /> [DEPARTMENT USE ONLY <br /> SITE MAP 1N ll NIT TV Fps ADDRESS <br /> WORK PLAN DA3'EW ld woz <br /> q�plrca#ion'A=oW�5+_.,.,� --�a"' --- —Date 1W.U -. <br /> Gmm Impettm Dm renal Impec don By J'I <br /> Da <br /> >aB�Inst�ctlart B E3� ' <br /> COhlfdDrl3'S!Ct}E9DrTI4tZ5: <br /> AC=UNTING ONLY: AID& FAt* <br /> PE 9 FEE tWG AMOUNT SiMIVIM CTtgel<# RIrCD E3Y flA►TE PFRUITI sEri SCE RFQQSSI# WVOECE <br />