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t35/05/ 006 17:29 209522d' ' t GEOLOGICAL TECHN'" PAGE 021$3 <br /> I <br /> San Joaquin County. FD� <br /> Environmental H61; th Department W u 4�-4SITE <br /> 304 East 9c A2A9,3rd Z <br /> DM, <br /> �Veb-cwww.sjgov rnrglebdkton, CA 95202 '�A O�ITIGATION <br /> • (209} 6s 344 ( } UNIT IV <br /> Well Permit 4pl+cation ENVW t,�J IENT.E L <br /> NON-REFUNDABLE PERMIT EXPI41 YEAR FROM DATE ISSUED <br /> Appl;catian Is hereby made to San Joaquin County for a permit tD aonstnrctlindlor Instal the work described. This applmlk n is made In corr"nc a with San <br /> Joaquin county Development Title,Chapter 0-1115.8 and the Standards oiUn Joaquin County Erwlronniantal Health Department i <br /> S side b N side of Charter Way tent Street Slocktnn 95207 M8 City Steet <br /> WELLLowtlon Cross Street_. City Zip <br /> PROP01TV Frank Moats 814 E.Charter Wal Stoci<ton Z 95207 Phones (209)4T9-76+16 <br /> owns, Address y;. city ro <br /> (916) <br /> nc o r ova 95742 638-6664 <br /> C-57Contmator TestAmerica Address 31t35LtlyUnGD►1 . �y Zip Lidrt3_9548Phanaiq <br /> ConsukancJSub G Goolugical Technics Inc Adder 1141 7th-Sftrest sty Modesto Lico nla Phone# (209)522-4119 <br /> (us Coordnalas:X 'Y TowtW Np Range Section <br /> V11 ORK TO BE PERPORMIED: i <br /> Q NEW WELL 1 BORING (CPT,GEOPROBE,HYDROPUNCH.HA]D-AUGER.OTHER) p DESTRUCTION (choose type below) <br /> 0 SOIL BORING M SR-1 A SE-3 0 OVER480RE. DIAMETER <br /> p WELL X a PRESSURE GROUT <br /> Q'Qthar i GROUT SPECIFICATIONS <br /> COMMENTS: See Wok Pian dated 11/30/2006 and Work Plafj.Addendum dated 6/13RI7 _. <br /> TYK OF YMEt.L IMSTALL ATION TYPE rANSTRUCTIOh''I''ApPEOIFlCATIONS <br /> 0 MOMTOWNG 0 HOLLOW STEM DIA.OF BOREHdP.F,_ ©MULTIPLE CASINGS p MULTI-LEVEL WELL CASING DIA: <br /> 0 EXTRACTION 0 AIR HAMMERIDRWN CASING THICKNU§S TYPE OF CASING: a STEEL p PVC a OTHER: <br /> (]VAPOR 0 MUD ROTARY DEPTH OF GROLP SEAL TREMIE TYPE TO BE US®: Il AUGERS 11 HOSE <br /> 1]AIR SPARGEI OZONE Q PUSH POINT(SP vrCPT)GROUT SEAL PU BIPED; p Ye. 0 W (NOTE:MAXIMUM FREE-FALL DEPTH IS 3011 <br /> 11 SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br /> a OTHER: n OTHER APPROX.BORIPK DEPTH 0 BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> CONDUCTOR C4tING� PROPOSED (if YE3,ist apecilloations in oomment sedlon) <br /> COMMENT$: ft Work Plan dated 11/3012006 and Work Plauapandum dated 8113/07 <br /> 'i <br /> NOTE: OFFSITE BORINGS REQUIRE_ACC 4S AGREEMENT OR ENCROACHMENT PERMITS. <br /> 46 WORKING HOURS NOTIOE REQUIRED FOR INSPECTIONS. <br /> OS. <br /> hereby certify that 1 have propW*d this application and?hat the work will be done in accordance with San Joaquin <br /> County Ordinances,RUWS and Regulations,and all appli ble Callfornia late Laws. <br /> Sighed z i Trfle/Campany r% I"A/iL //lL�J1eF4�1✓ <br /> t— <br /> Print Nome P Date <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNR IY FILE,ADDRESS: <br /> WORK PLAN DATED: <br /> Application AccepAed By r/G r � �i[/J e/��#'! Date Issued te,,sem Ship& t, YcsTA�,-, a �Y 53 <br /> gout Inspection By, /Vi /1 Date Final Inspection By /1/G rLf Date/a/F <br /> Dealruddon kupwdon By Dade j <br /> COMMENTS r CONDITIoNS: <br /> ACCO UVT14G ONLY: AID* ' FAC* <br /> 06 CODES FEE NIFO AMODNT REMITTED CHECK R RECD BY DATE PERMIT I SERVICE REQUEST 8 INVOICE <br /> SRX po 53 2 3 7 <br /> C-57 WC -WAIVEk-- C-57 Latter of AuthoFization to sign permit, Encroachment dos <br /> ooz-°°' 0053Z3 vpda4� 5/2�/Q� i. TStAmfvKcc <br /> /le- <br /> Z'd lVL9-9E9-9L6 d.Ioo Buipiaa e01aeulV19el 9�0:60 90 90 AeW <br />