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' 08/05/2803 15 36 2994683433 FIFTH FLOOR PAGE 02 <br /> o �,��, <br /> ���.' V1iLL pE � 'AP�'L1CAT'� M �Q��+t SITEw <br /> E ` 1 <br /> ' SAN JOAQUIN COUNTY MITIGATION <br /> JUN 19 2003 ENVIiRRONMENTAL HEALTH DEPARTMENT (EHD) UNC' IV <br /> ENVIRONMENT <br /> HEALTH 304 E- Weber, Third Floor, Stockton, CA-, 95202 <br /> PERMIT/SERVICES (209) 468-3"9 <br /> ' NON-LIMNDABLG L M141Y 99M0 1 YEAR FROM RATE IS'a._E'S <br /> Appli at on to hereby Ruda to San,loaqum County fur a permt to cmstrud and/or wWd the v o*riesa lbed. Tbg5 applicafton Ls meds in co Mlanco W M San <br /> Ja�nry�Cam*Deveia Ment Title,ChapW 9-1115.3 an She Standards Sari J n Ccun Enmronrrm al Ffwh Depertrnent <br /> of Sto P i+r}• • +may �I rr. ��a�. �sesso's 1 <br /> l7 1 - <br /> !1Lacttrlon crass5tremt .� r city fcc 'Ian �p 95200 groom <br /> tES{Y1rt �'° o� 3Z , �- opgAo dr d t / M 1 <br /> PRO tr rG�.�v 9 h�r� <br /> i:-�r Conttac�o+' C�°►Sc ��o�[„! ; Address�t.3 >� G� Cary_cplz� �p 191"Z- 7I 7514Phav o�(s £:3L 116L <br /> tCarsaftrd/SubC* h+_6_E- _ _A l�:59& Cn Sf:a—CfP�L[df�� *�Z 7 Phone y ^/0a 1r <br /> y GLS Caorci]nates.X .Y TownStt�P___-- - R;mge - Sedari— <br /> V.4gM TO ft PERMED- <br /> NEW WELL I BORING I CPT,GE0PRi3BE,HYOROPUNCH HAND-AUGlT,OTBEW) I)DESMUCTION(,:h=e type bebw) <br /> p SOIL 'G <br /> aOVER-BORE <br /> ,KWR.I_# Mtia��o - j _ fJ ll �s GROUT <br /> �Qther GroutSpeacations f D - � E <br /> COIUIMENTS Ss~� APPR�v�,D �I�1C 1�4N r�l�_._. >'4,P_�I'I_ �3y �c3o <br /> TY_pf=CIE WELL 1Mft L.A't N TYP15 CONSCRUCTION SPEOFICAMI S d N <br /> ONI TORING VICUOW STEM DIA.OFSOREiOL>W MULTIPLE CASINGS?)(MLI1 TI4.EVEL-7 Il WELL CASING DIA. �a 1 <br /> Q ON jl)UK IjAMIYttERiORNtI CASING THICIWES9 [N�4 0�' iYPE OF O1h5INC 11MEL [i PVGc THE}?. <br /> VAPOR LI rS7 7 <br /> MU7 RCFTARY DE T!1 OF GROUT SEAL . MT <br /> )(HOSE <br /> SPARGE!Ozone p PUSH POINT GROUT SRL PUMPED Yes a No (NOTE:MAXIMUM FREE-FALL. DEPTH IS 301) <br /> ' IILBOWNG aHAND AUGER GROUTSPECIFICAT1ONS fofir! 'r �_ � - — <br /> I OVR ER�-, jj OTHER APPROX BORING DEPTH ,J F7• QL1ED TRAFFIC SOX ar U STOVE RFIE <br /> CONDUCTOR CASING PROPOSED? l (If fkst speaiicatons herep— <br /> i <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERmn S. <br /> iCALL THE UNIT IV~'INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL RI_-QUIRED INSPEO 1`10NS <br /> hereby tertify that I have prepared this application and that the Work will be dme In&-.cordance with San Joaquin <br /> :aunty Ordinance, Rules and Rtslabons,and all applicable California State laws <br /> 34gnad.x T[tlaJ(:orrfpany 4*Eur <br /> 3rnt Nan s� i Q v DWe p -- <br /> ' DEPARTMENT USE ONLY <br /> ME-MAP IN UNIT IV FILE,AaORrz$5; S I~1$ r <br /> ' NORK PLAN DATED; April -2062, - <br /> 1*ImWn Accepted lel' ,Y;e-4OY-1iL - M PeAY' 1 _ Oats L-wed��t -Z Aram— <br /> ' arwt hupecdon BY. Dale -IfRad Irmpection By — <br /> ]estruckc hgm2w lay Dare <br /> :OMMIDITSI CQNDMNS. <br /> ' ACCOI,WnNG ONLY` AM <br /> ' ��qqES FEE INFO AMCnW�'"M CHECK$ DECD BY DA-M PE Iff I SERVICE REWMT 0 WVOICE �3 5"0 I $q. dd 99,00 1)0 34-Sof <br /> -57^ We._1NA�i» C-57 letter of Authorization to sigh pertnit__-„--Ertcl-nachns rrt doe 8!29/02 <br /> i � r <br /> t , <br />