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10) <br /> San Jvagain County <br /> Q ED <br /> Envir©nmentaI Heath DeparopenUp 2 4 2005 SITE <br /> 304 Bast Weber Avmme,3rd Fes,SWckton,ftft%ENTMMOAT#DN <br /> (209)468-3449 Fax (209)468-3433 Web:www.sj� VH���TH U1wNtT IV Pehm#t Appt#catton <br /> torr. MWAS 1 YEM Mel DATE ISSUM <br /> APPk�sn k her�sby mads to sae doa�n CounW lora pwmk to conal O smLtr kaw fw wwk dea MW. This eppkasm It MS In anmPiwm wNh son <br /> Zsquke Cm*DsysbPmerN T<fls,OmPbr 9-1115.3 and the SWX%rda of San.bsqu County EnwimmomW 1 k" Dgwbnent, <br /> wEL tae0Mwr \\QXD N . Q c o.,dw0 _c m"Sb"Vel e,.- . CtgrS" 4K <br /> PROPERTY N :0 i- n�� Sv�t�a f1 32vS <br /> �- ug <br /> owrwr o. reaa LSI•z .�� O� a s�� s3sop 51 b - a g3S <br /> C47 Cantraaor to�p Q d� qp►�s��'r`�°►_5,-b�'� rryo„eE �►tb ' <br /> 40 <br /> arirrSast , rGwt <br /> °! 5�� <br /> dts Cooradlnobc Y, - _ Y.. . Townet -.___ „RaW Seaflon <br /> o NEW WELL f BORING (CPT,GES,HYDROPLq CH.SER,OTHE" p DESTRUCTION (choose 4"be <br /> NSolt.6ORINIG 3 _G <br /> DOVER-BORE. DIAMEM <br /> a YELL s U PRESSURE GROUT <br /> ar GROUT SPECP)CATIONS <br /> EnaLm" ItlETdi�1t4I!-�� <br /> II MkNITORI NG a HOLLOW SEM DIA,OF BOREHOLE_ a MULTIPLE CASINGS 0 MtLTI-LEVEL WELL CASING DLA: <br /> 0 EXTRACTION a AIR HAMMERORlVEN CASING THICt TYPE OF CASING. p STEEL Q PVC a OTHER: <br /> U VAPOR o MUD ROTARY DEPTH OF GROUT SEAL,_TREMIE TYPE TO BE USED: Q AUGERS a HOSE <br /> G AIR SPARGEI OZONE 1)PUSH PONT(OP or CPT)GROUT SEAL PUMPED; Q Yee Q No (NOTE:N A)MlIUM FREE-FALL DEPTH I8 3W) <br /> 4 9OL BORING Q HAND AUGER GROUT sPEctFlCATIONts <br /> a OTTER:_ l OTHER— APPROX.BORING p BOLTED TRAFFIC BOX or 11 STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (if YER,IM 4wMatlo w in eor mwd mdion) <br /> corlrl�nTr; �_ b — 1'-} • n S a�- �yP a <br /> NOTE: OFFSITE BORINGS REQUI ACCESS AGREEMENT OR ENCROAC NIENT PERMITS. <br /> 48 WORKING HOURS NOME REQUIRED FOR INSPECTIONS. <br /> I hwvW OMW hart 1 haveprspairod tltb appikadw and that the wwk will be data In accordance whit San Joaquin <br /> acrd ah appNm&e C amfomla State Laws. <br /> ?L <br /> n - Ttge/Companyr . <br /> DEPARTMENT USE ONLY <br /> SITL MAP IN UW N ADDRESS: <br /> YORK PLAN DATED:—AaZff MAZ <br /> APPenAmpbd By, _ --- Dais ksered Area Q4 7 <br /> Grout Date FkW huppoon By Data <br /> C a 11101 To I COMDITIOW <br /> ACCOU14TMIG ONLY: AIa]al: FAC* <br /> PE 00098 W Wo AIIIOtW REINTTBD CHECKS RECD BY DATE PERbWT 1 SERIWIM FAMEST d 110101011 <br /> •ot S4- 6i7 %h AV- e SR# ao <br /> C-57 WC -WAVIER,_ C-57 Letter of Authorlwhon to sign perms# Eneroachmw dot <br /> eta z9-aa-a» <br />