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Jun-28-99 08:40A ECA, Inc _ -Tahoe City 530 581 0389 P _ 01 <br /> +511!6.188494 0C ENV I RUNMENTRL Is <br /> 554 P02 JUN 21 '99 13:38 <br /> R't <br /> 'T txc WELL PERMIT APPLICATION FORM UN IV <br /> 6LA -- - <br /> SAN JOAQUIN COUNTY PU13LIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION ("PHS-EHD') <br /> 304 Ir. Weber, Third Floor, Stockton, CA-, 95202 <br /> (209) 468-3450 <br /> MON-REFUNDABLE PliI EXPIRES 1 Y FRAM DATE ISSUED <br /> 1pl.caEen is hereby made W Sul Joao W County lora P+Wt CO CV Mal III instill Ort Mwk desvited. i <br /> ha sP�M Erb�ebprrynl T)ee.Cnapgr 9-1115.3 ane Me standards or San aPelidOon is.node M can sa enlh <br /> r ,lvapmrt Ctlunly PYNI('freek Senkys.EnviramWMal rNaltanb Dh.aipn, <br /> ELL Locatlarr L�c+r:L+I �b +. DD J C �, aeti <br /> Cl. r �, Aaors <br /> Pamefft` <br /> eDPrsnTYo,.,e,�/ S. �r,„„ pyTC_Adersss <br /> 57 Convww <br /> ---�Y,.__ _laP.�lits Phontk <br /> .�Xant/dub Conbacwr � ..:rsn u( Addeas�9 7� Cr�-ell�. y t 00 Crty a 4 a Lo Plwrrr 51d - 6 i B-SY00 <br /> $CeonWlMea:X__ Y„_ Tp.�ah <br /> Range <br /> QRA TD eE PERFORMED —--"–� --- _ <br /> NEW YVELL/BORING 1 CP GEOPROUE HYOROPURCH.HAND-AUGER.OTHER') D tsESTRUCTfO <br /> c ft N doese I"&bolo.) <br /> 0 WELL Y D OVlR�ORJ: <br /> Oren. 0 PRESSURE GROUT <br /> - <br /> L.7�c.T <br /> P� WELL crus uCTION ryve rp UCTION SPECIFlCATIONS -- <br /> 2XYRACRING 0 KQLLOVV STEM DIA,OF BOREHOLE MULTIPLE CASINGS71{YES ■NO wFLL CASING OW!JA <br /> �ITRAC7ION 8 AIR HAMMERIORNEN CASING THICXNFSs A TYPE OF CASING, 17 STEEL Q PVC 3 OTHER <br /> AP'OR U MUD ROTARY DEPTH OF GROUT SFAI. TREMIE TYPE TO aF IIS{D_ 0 AUGER$ 17HOSE <br /> UR SPARGE G PUSH POINT GROUT SEAL PUMPED, O Yrs 0 No (VOTE: MA)UMUM FREE-FALL OEP714 IS 301) <br /> =O11,BORING 0 HAND AUGER APPROX_BORING OEPTN Y- 5 r <br /> )THFR 0 BOLTED TRAFFIC BOX or !1 STOVE IxPE <br /> CONDUCTOR CASINO PROPOSED)_ (/YES.LH speeiTnkorrs hen): <br /> •MMENTS: <br /> NOTE: OFFSITE 9ORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS! <br /> 1�Y •1 I Invw PmOanrd this appl;rAtlon am OnM Oa`spin t✓a tlone�n N.[d.darncc wsn <br /> I Repnaalions of Ur.San Jasquin COY > M Ors,Slate Live,and Rugs <br /> edrich dNs ntY. MOfn.eUlnlN d Ynnaed agen.Cs srgnnwe ce.cRes Yw(1 `7 o.rd/y ewe M 09 MMee perfbllraaep of tMa vara 1 <br /> Mmwt is iasRed,I shay.rof errndor Pomona wbject to NORIWAM'S COyPEM4A7rOx[.wa wCaLnbn,la.^ cw4factors hung or wb- {( <br /> W” oprliTes the folln..ing--1 ,nly that i.Ari.vaAo,ey,Ky of a*.ora Aur which fits pwnw:s as...d.f.sPei aYnP'oY PersPns s,41I ID <br /> VWALWS AO-ENSAn wGeradcaNwn_ 1) <br /> PU NT MUST CALL 48 HRS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. <br /> we h,�� � �,� VAt�l; <br /> _ TAII�LTsL� Oau �1 Q -1 ; <br /> EE SI E MAP IN UNIT IV WORK PLAN- DATED <br /> OFP&Rru&wr USE ONLY <br /> katios ACOePIbd fry____. _Data laeued� Arta <br /> '+1 Ina)rusron 8y Dim (Seen enpacor.By_ Dale <br /> atI IRA paatien B�r Oaf --�- <br /> AMENTS i CONDfTIONS: <br /> ZOU INTING ONLY- AIDe FACT <br /> CODES FEEINFO AMq)MTREMmED C11r�KWCASNIiECl:IYiD ell DATE pERMRSERu1C6+>✓<OUc"'ST NUMBER WVWCE <br />