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09406/2007 11:42 <br />PE coars <br />9166385611 <br />CASCADEDRILLING <br />PAGE <br />02/05 <br />09/05/2007 <br />17:24 <br />5102904 <br />ETIC ENG. OA <br />I•Aun <br />04reo <br />,San Joaquin County <br />Environment Health Department SEP 13 2007 SITE <br />.. 600 E. blain Stri Stockton, C.A. 95202.302tN �NMENT HEALMITIGATION <br />(209) 469.3449 Fax: (209) 468-3433 Web: Www,sjgov. IT/SERVICES UNIT IV <br />Well Per It Application <br />NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM DATE ISSUED <br />ApPGcathn is harnby Made to San Joaquin County for a permit to construct andlor install the work described. ihlS ApPl1e01011 IS mads In oomplianoe ar th San <br />Joaquin County Oevelepment Titla, Chapter P-11 16.3 and the Standards of San Joaquin County Environmental Health Department <br />A6aaaaora <br />WELL Location3508 N, EI Dorado St Cross Street E• Euclid Ave. City StodkCo�IP 95204 Pavy# 1'19.13.-066 <br />PROPERTY FirSt 8904iSt Church ArI,lrneN �' O5 N. EI <br />0s7 Contmotor Cascada Drilling, Inc. Addrasa 3622 Or <br />Consultant / Sub CMr ETICEngineering,tnc. ddress_ <br />talc Coordinates: K_, Y_ <br />WORK _T:O 6§ PERFORMER: <br />g NEW WELL I BORING (CPT, GEOPROBE, HYDROPL <br />n SOIL 9ORING 0 <br />PE coars <br />WELL # <br />AMOUNT REMITTED <br />II <br />CHECK R <br />I]'Othrr <br />I OATE PERMIT f SERVICE REQUPST # <br />)wolcE <br />COMMENTS: <br />,u -N <br />S9 •va <br />TYPE AF_Wd.l. <br />1 A4 P <br />CONSJJ <br />X MONITORING <br />11 HOLLOW $TEM <br />DLA. OF <br />9 ptTRACTION <br />g AIR HAMMERIDRIVEN <br />CASING <br />p VAPOR <br />p MUD ROTARY <br />Clam I <br />O AIR SPARGE! OZONE <br />u PUSH POINT (GP or CPT)GROUT <br />n SOIL BORING <br />n HAND AUGER <br />GROUT <br />BOTHER: <br />la OTHER <br />APPRO <br />I hereby certify that I have <br />County Ordirl Rules <br />Signed x <br />Print Name_ ✓l <br />SITE MAP IN UNIT TV FILE, <br />WORKPLAN DATED; <br />Application A=ptad By I.l <br />Grout Inspeotinn Sy <br />oestructlon IrSpeotion By <br />C,oMit1PNTS I CON DITIONS: <br />Ado St. City Stockton 71p95204 phone# 209^4664368 <br />nc 1i ° <br />r 95742 <br />ret, <br />^CltyCordova 21p�1.10017610 pn0 916.636»1169 <br />s Morello Am PleaSai 624022 925.602.4710 <br />rtiv ..... Lldt PMOnek -- <br />Taumahlp 2N Ran9e 6R secdon 34 <br />HANO-AUGER, OTHER-) 0 DESTRUCTION (choose typa baluM <br />Q OVER -BORE. OIAMETER <br />U PRESSURE GROUT <br />GROUT SPECIFICATIONS <br />�REHOLE a•2,5, R MULTIPLE CASINGS g MULTf-LFVRL WELL CASING CIA: <br />acKNESS Seh, 40 TYPE QF CASING: d STEEL R PVC A OTHER: <br />GROUT SEAL 26 fL TREMIE TYPE TO SE USED: $ AUGERS II HOSE <br />Al,, PUMPED: 0 Yes p No (NOTE: MAXIMUM FREE -PALL DEPTH IS 30') <br />BORING DEPTH 45 ft. 980I.TE0 TRAFFIC BOX or d STOVE PIPE <br />OR CASING PROPOSED no (if YES, list speeiOaalomg in comment secaan) <br />FORKING HOUR$ NOTICE REQUIRED FOR INSPECTIONS. <br />odtthlS appiicatldn and that the work Will be done in accordance with San Joaquin <br />g$ulatfons, and Ill applicable California Stats Law . /tr <br />TluefCompony M J— ��"" ` e I II <br />1zw'eaE:Date <br />DEPARTMENT USE ONLY <br />SS: �hy� win—---^�(L-a 'iti� S,'f <br />Date Issued, C1( 1 41i} _ Area <br />Final Inspection By I[AL ... c — Datez� o <br />ACCOUNTING ONLY: AID* CFI <br />PE coars <br />FEE INFO <br />AMOUNT REMITTED <br />II <br />CHECK R <br />RECD 137 <br />I OATE PERMIT f SERVICE REQUPST # <br />)wolcE <br />pro \ <br />,u -N <br />S9 •va <br />TI `i o} SR# C(5 <br />C-57_ WC,_- WATVEP. C-57 L6ttoro Authorimli6n to sign permit_ Encrcachmen9' dec_ <br />ARD 29.02.001wcb <br />04.2/04 <br />FILE COPY <br />