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JAN J0APUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENV1Rt 'ENTAL HEALTH DIVISION ("PHS p") <br /> 304 E. V ober, Third Floor, Stockton, CA-, 95202 <br /> (209) 468-3450 <br /> NON-REPUNnAS( E PERMIT EXPIRES 1 YFAR FROM DAT LI—SUED <br /> 'kpoiJoaquin County D veto is County made to San-Joaquin Coun <br /> San Joaquin for a Permit to consat andior install theont wdescribed. This application is mado in compliance with <br /> p"n Tttle aptef tru <br /> 5-111S.3 and the Standarls of San Jaequln County Public Health SelViCe6, Environmental Hsalth Division, <br /> WELL Location <br /> Cross Street Californ�y Stocktonzrp 95201 atc ,.w s <br /> PROPERTY CM'nerCltY Of Stockton <br /> C•57 <br /> Address City Hall Cay Stockton? 9520? <br /> h <br /> P.�._ oneM <br /> Contrna <br /> Consultant/Sub Contractor thiI1 & tr)r ri n,,dres4 <br /> Cm' _lid PhonaY •I lta3 <br /> 315 Coordinates:X y . <br /> Townsnip Range Section <br /> ��NQRH TO BE PERFORMCQ <br /> NEW WPIC!BORING(CPT. GEOPROBE. HYDROPUNCH, HAND-AUGER.OTHER-) <br /> 0 SOIL 80RING r_ 0 DESTRUCTION(cnoo6e type below; <br /> WELL K 0 OVERBORE <br /> Other, p PRESSURE GROUT <br /> COMMENTS: <br /> -Ype br WELL CONSTHCTION TYPE CONSTRUCTION SPECIFI�ATION3 <br /> TJ ,MONITORING 0 HOLLOW STEM DIA,OF BOREHOLE MULTIPLE CASINGS? YES <br /> EXTRACTION 0 NO WELL CASING DIA; <br /> 0 VAPOR 10N 0 AIR HAMMER/DRIVEN CASING THICKNESS '!YPE OF CASING. 0 STEEL 0 PVC 0 OTHER. <br /> 0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAT <br /> 0 AIR SPARGE 0 PUSH POINTPUMPED* <br /> TREMIE TYPE 70 BE USED: 0 AUGERS pHOSE <br /> GROUT SEAL PUMPED 0 Yes 0 No (NOTE, MAXIMUM FREE-FALL DEPTH IS 30') <br /> 0 SOIL 80 HAND AUGER APPROX. 3OPJNG DEPTH _ <br /> "` 0 BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> OTHER: CP 1 OAS CONDUCTOR CASING PROPOSED? (if YES, list speG(Icationa here} <br /> COMMENTS.- <br /> NOTE: <br /> OMMENTS: NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS! <br /> ..,.14141 "I I L_._ r._r1J.-U,l.Kra.-u_ _.,J lt._1 tL_ ..._�t._u ri„sA;■ Axisnouu woo fu Innnntn r nnnru nininvrin Slilr LdWi. ane hwil <br /> and Regutatloru of the San Joaquin County. Homeowner or 11censed agents Signature certifies the iniiowinq: "1 cerrliy that In the pvrlvrrrmdnce of fhc work <br /> for vactin ter=perm/"la Issued, 1 seal!nvr.m Eloy persons sub�eer rzs WORKA"AN'S CplRrP61JSATJON L]wr p/Ca!]Jomisl." Contrac1nr's hinny or autr <br /> _ontractinp signature CQrtifteg the Iollowing: 7 certify U?J7 Ll the performance.at NB wplk for"tc-1 ihi3 p@rmtf is issued, 1 srted @mploy parspns Subject to <br /> K'ORKMAN'S COMPENSA rION Lpws of C hAvr4la. <br /> THE APPLICAN UST CALL 48 HRS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. <br /> Speed r t'rtle9C � �_(}Q."(� bl Date_ 0_0 <br /> SEE SIT MAP IN UNIT IV WORK PLAN. DATED 5/12/99 C. Oz <br /> DEPARTMLNT USE ONLY p d' 2-/2 3/0,v <br /> Aop{ication Accepted By _Date Issued_ Area 7 <br /> Grout Inslrection By Da Fa1pi msptction By Date <br /> Oestrvction In4tMttion By _ 01 <br /> COMMENTS/CONDITIONS: �C <br /> ACCOUNTING ONLY AID# FAC* <br /> �5c <br /> OOFS FEC INFO AMOUNT REMITTED=iAHRECEIVED BY DATE PERMITISI=RViCE REC}UE3T NUMBER INVOICE <br /> -0I 3'/ - �l — 3/5`I CO `lllb I S R# -�oSyY <br /> )NIT ry- 6/99/ML - <br /> ----- -------------- <br />