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bl/Ub/Z0170 ZZ:Z1 5,3t7bbLtiloJL WDU EXPLORATION PAGE 02/05 <br /> 1:117/2007 13:59 530r )052 'JDC EXPLORATIC <br /> DEC-27-20@7 11106 a Cq�gR;q PAGE 02/04 <br /> 1'70 6 <br /> San Joaquin Countygulyy <br /> Environmental Health De `- <br /> Ps�rtment <br /> 600 East MainStreet- 5t4>cktan, CA 95203-3029 SITE <br /> \ (209)468-3449 Fax (209)468.3433 Web:ww'IvAjgoy,erg/ehd IV 1ITIGATION <br /> Well Permit Application UNIT IV <br /> NON-RLV pERMtT"PiRGS t YEAR FROFA 04TE(33UEp (�Jll S 1 T <br /> joam c fJ noroby nlyde to$Pn JOCQuM County 1w a ciemtd to eennpuet srxuor UM84 It,e wont pe-w1bed. This 4oPiioetion;6 M. �,!eornpNonce wAh sen <br /> ir CetrMy op+9toP�nt r Ve,CNYDOIF 9-11 T5 3 arrd the 3tandardy of San J <br /> OBQUIn <br /> MrQLC loerwor, County FFMlV rrontai M@e Ih 012-PBrifrrent, <br /> Streot�►J'� r4-�Y .. A�iusseon <br /> Ormtl E J� f Fad q y53 V.,J,+�t.rbd� <br /> __Address <br /> C.Iey Centroder � �p� <br /> onswon hue env w� � rfft �c�t�yp_ _l �t c, �ct� e1-r3Addenf� . <br /> GIS Coondinawr >�_ _ y �s �--�tt><atur oil �o _ -�.t 6 9 <br /> .Towngntp <br /> � CawoaJBOmit <br /> INm <br /> ORING# . ROL hIYDROpU <br /> 4AND-ALIGER.OTKER•) aRaD^AEeBTRUCTIONRG (teraeoP <br /> Bw,ser�u�n <br /> (chon!t: ypeblb.) <br /> 0 OVER-et7RE. OLWeyER_ <br /> r d PRESSURE:GROJT <br /> C OMMEWS: GROUT SPEC FICATIONS <br /> MaL ec nrFLi COMA u ---.�— <br /> PQAOMTOR1Nsp jMOt LOW STEM : Ota OF 80REhtOt 6j <br /> Q EICTRACTIpN a A1R NAMkEkAaAfYEN C '�'fPLE CASHVQ$ Q MULTI{EVEL VA;L1.CASING DIA: <br /> 0 VAPOR M CASING T►irpCN683 R TYPE OF CASH. <br /> Q UD RQ7ARV DEPTH OF GROUT SPA �� L IJ 51 EE7 /�PbT.' ,a OTHER:��- <br /> 0 AtP SPARGFI OZONE p LUSH POINT top e, Vi ,�.Jt Wj TYRE TO bE USED �IILn.Ut:r:RS �MOSE <br /> Q Sorl BORING t'eROUT SFAL autyvEp.Myas No (NOTE: fUMUM FREE-FALL DEPTH IS JO') <br /> 0 RANO ALtQ GROUT SPECIFICATIONS IIP I <br /> D OTr `�Y�ATHER� A"ROx.SOMI - <br /> NG DEP7w <br /> CONDUCTOR XPOLTEDTRAFFIC BCjX or LISTOvE ppE <br /> //S tsrNt;PROCpgFD <br /> COa1M6NTB; —2 r /l ��y0 f ()f YGS.141 ZOs'afMinns..n eomnrent sea'on1 <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR • 1 <br /> 48 WORKING HOURf;NGROACHM <br /> S NOTICE REQUIRED FOR I OR 1I GR I~MT PERMITS. <br /> h6feb <br /> I *Untyr cl�ttty that I have P�PenQ this appllcatlan Land 0"d the work wllt be done in Ottardance with S IIn Jas uin <br /> Cognty Oc+rlhsat e5.R al Regutatians,and all aall <br /> applicable CaliforniaCaMliL"S' 4 <br /> Pnrn NanoTae+comaarry DC <br /> . <br /> - safe / '7 G <br /> EPARTIMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE, ADDRESS. A;I & 7 <br /> WORK PLAN DATED: L0 <br /> APPlkenonAmepled - ---�, <br /> Grout tnspeeson Illy in IttSu! . r na <br /> O"M-0-tnspsnron By DaN 1� p �p�at hwelton or - <br /> Ddle <br /> COMMENfA/CQNDtTIOMA: �..•�a.. <br /> ACCOUNT?NGa ON�y; A100 . <br /> AG <br /> FEE INFO AMOUNT RI:MMTTFD CHECKrR -- <br /> R6C'0 131 DATE PERI111TJ SERVICE RE011r ST r 011'"09Asa! 'S9Yaao � sau <br /> we-WA 7 6 5 3 0 7 <br /> IVER_-- C-57 Letter of Autherlyatic,to st ermiY - <br /> awv r�•os-0m WEB 9n P ._.EncroQchmerrt doe <br /> 9r,1rzoo7 - — <br />