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09/06/2007 11:42 916638 11 CAS`ADNDRILL �MuAGEo�04/05 <br />09/05/2007 17:24 51004 <br />San Joaquin County W-- <br />°� Environmental Health Department SITE <br />a 600 R. Main Street, Stockton, CA 93202-3024 SEP 13 200MITIGATION <br />r" (209) 468-3449 Fax: (209) 468-3433 Web: wwwsjgov.gr0j40NMENT HEALTH NIT IV <br />�r Well Permit Application IVPVIEnRMIT/SERVIC$ <br />NON-REFUNDASU! PERMIT EXPIRES 1 YEAR FROM DATE ISSURp <br />Appilc0on la hereby made to San Joaquin Counly for a p00utto construct and/or Install Ilia work desodbed, This application Is made In complianCe with San <br />Joaquin County Development Title. ClIeptar 9.1115.3 and the Standards of San Joaquin County ENrn mental Heade Department <br />Assessors 8.007 <br />WELL Location, 3232 N. 61 Dorado St. Cross Slroel E^ Alpine A`m• City Sleokton in 952013 portal# 125-j <br />PROPERTY Robert A. Sullivan - Address 3232 N. EI Dorado St. City Stockton zip 952134 Phone# 209.948.0501 <br />owner ens 0 <br />0-57 Contractor Casaade Dltlling, Ina AtltlrL^as 3632 0mec Circlo City GGLd9va ZIp95742 Le# 17510 phi 91e•038-1109 <br />E71C Engineer ng, Inc. 2285 Mbretto Avra, Pleasant UEN 624022 phone# 925.80x.4710 <br />Consultant l Sub Cntr Addross----City^tw <br />GIs Ccordinsisti X , Y Tawnchlp 2N Range eE SeC6en 34 <br />N,ORib �E P� FOR RMED: <br />$NEVA WELL /BORING (CPT, GEOPROBE, HYDROPUNCH, HAND.AUGER OTHER71 p DESTRUCTION (choose type heloWp <br />p SOIL BORING # Q OVER -BORE. DIAMETER <br />e WELL O—NL%a Q PRESSURE GROUT <br />Q "Other GROUT SPECIFICATIONS <br />COMMENTS; <br />TYPE OF WE1J,. INSTALL. TION TYPE AoN6TRUCTION SPECIFICATIONS <br />MONITORING $ HOLLOW STEM DIA. OF BOREHOLE --2-6" Q MULTIPLE CASING p MULTI-LEVEL 1NELL CASING DIA: <br />p EXTRACTION Q AIR HAMMERIDRIVEN CASING THICKNESS Bch. 40 Type OF CASING; D STEEL R PVC 0 OTHER: <br />Q VAPOR Q MUD ROTARY DEPTH OF GROUT SEAL 28 ft. TRRMtR TYPE TO BE USED: S AUGERS Q HOST <br />Q AIR SPARGE1 OZONE 8 PUSH POINT (GP or CPT)GROUT SEAL PUMPED: Q Yes a No ((NOTEuMAXIMUM FREE -FALL DEPTH IS 301) <br />p SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br />p) OTHER: R OTHER APPROX, BORING DEPTH 49 ft $ BOLTED TRAFFIC SOX or IISTOVE PIPE <br />CONDUCTOR CASING PROPOSED no (f YES, fiat speocationa In Comment section) <br />.UARMPtd... .. <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 />County Ordinance , Rules an gulaltlonc, and all applicable California State Laws. <br />Signed xr , _ Thw/Compony M Com' l C C �iC.Lt. d� h (� kGi t I n l'r <br />Print No EYY�I ��%�� nate cj Lo Ci <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS: — v r� f t3o� IaP Sr & <br />WORK PLAN DATED: 413o(0P,a aMncu��1� <br />Application Accepted By^ U1,,. Date Issued <1 14 r�� Area <br />Grout Inspeglon BY r h- Ate^ �� Date I incl InsPectlon Sy 1 � ACDeta�— <br />Destruction Ina ectlon Rv Date <br />COMMENTS I CONDITIONS: <br />It <br />ACCOUNTING ONLY' AIDA FAd1 <br />PE CODRS <br />RSH INFO <br />AMOUNT REMITTED <br />CHECK* REC-D BY <br />DATE PERMITISERVICE RB@uPAT # <br />INVOICE <br />;toj <br />$S4a <br />z{ssa4 GC <br />9No} SR# S �cjS� <br />L.57� WL_•WAIVEA C-57 Latter of Authorization to sign parmlt_ tncraacnmenr avc_ <br />,LRD19A2-nClurot, FILE E <br />"ZIm° COPY <br />