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4 <br /> 06/01/2009 13:02 7073745FII� PAGE 03/03 <br /> Jun 01 2009 11133FIN CRR 51042 , <br /> • � • • <br /> SAN JOAQUIN COUNTY JUN O 1 2009 <br /> ENVIRONMENTAL HEALTH DEPARTMEN VIRONMEN7 RDWfi <br /> ° 600 East Mein Stns®t,Stockton,CA95202-3029 PERMIT/SERRATION <br /> Tdophono:(208)488-3448 Fzw.(209)488-3433 W00:m".jrt aov.omrohd UNIT IV <br /> -i <br /> WELL PERMIT APPLICATION' Popp NON- REF t�DAALE_PERMIT EXPIRES T YEo <br /> AR FROM L ATE ISSUED P <br /> Application la hereby mads to Sen Jaequin County for a permit to crnetrtid endfor MOM the vrertt descAmd. This application io made In L=nplieroo with ssn <br /> Joaqu'a County Developmam Ykle,ahopwr 8-11 ta.S and th?6tprdarda of Son Joaquin County Enviroementel Haslet Department. <br /> Atsss-dfrs <br /> IAfeO Locatlon $ o Croda stTset ; t' IZd. Cly _Zip gs41 s Perces !(%;`710D.3 U <br /> Pro 4 t *� od G 3aS -- <br /> tTMnts Addrara City,. - 810_ Phorsa , <br /> C-57 Contractor YV"Wdf/1Dr4 Joddress 50 KIVW RQ! cit Qia VjSS A LI a'fi7APhone 107--37q-XWD <br /> onouRa <br /> Bub Cntr Ufz:,;R J4 Addre94Jr7 !�u!/r S��GFe. A Cty rhe Y,�;1� th4 Phone ;49. �a0.334( ` <br /> GIs C•oorDlnatmX Y Township Range 3act)on <br /> K.RFOPI=O, <br /> H L- DIUNO(CPT,GL°OPROGE•HVDROPUNCH,HAND-Au Or1fQR'y CI DEIITRUOTION('CHOOSE TYPE rm" <br /> Shc'L BORINGS3 _ ❑OVER-BORE DWMETER <br /> yjr--LL d M W"'R Mt 0 PRESSURE GROUT <br /> ®'0TH GROUT SPECIFICAT <br /> COMMENT$: <br /> neg OF VYELL WAYALLATION TYPF• CONSTRl)C11014 SPECIPICAT1oNG <br /> ffi KMITORINp k}NOLLOW STEM OtA.OF EOmme •IO" E)MULTIPLE CAG(NO9 Q NARTI•tEVEI VYEL CAGING 011k 9 e rt <br /> 0 EXTRACTION 0 AIR NAIAMBRIORIVEN CASINOIrMiCKNESG ILIA.'IQ TYPE OF CASING:0 STEEL M'PVO ] OTHER <br /> O VAPOR D MUD ROTARY DEPTH OF GROUT SEAL WA-661-1 TREJIAIE TYPE TO(3E UHED O AIJr---RB(tHOGE <br /> Q AIR SPARGefOeONS Q RUSH POINT 40P OR rf rL_GROLH SEAL PUMPED:C1 Yso 0J�,,/!No(NOTE,MAXIMUg1 FREE•fALL ID8TN IS 30) <br /> 0$OILBORAH <br /> INO 0HDAUGER GROUT SPECIFICATIONS taf r t�ut!► ft-z! &rromt <br /> Q OTHER: 0 OT}WFI: APPROX.GORINOT DEPTH 4%,s R m t <br /> OONCUVORCA9N0PR0POB50 �p°dfFutivsi Ir c'rrrMr �OY!?PIPE <br /> COMMENT& <br /> NOTE: OFFSITE BORING$ REQUIRE ACC988 AGREEMENT OR ENCROACHMENT PCRMITS <br /> 40 WORKING HOURS NOTICE REQUIRED FOR INSPECTION$ <br /> 1 hareby axtlfy that)hM pnparod thla application and 11,11118 wont VIII be done 1 aeoonaance with San Joraouln County Ordlq—iloos,ttvlea and <br /> R80U1=I0nc6 and all eppDechin California lrwo. <br /> signedtE8lCompany <br /> 1 / <br /> PItR Nerveio Owe_ <br /> DE0qq ARTATE T U SE ONLX <br /> SPIE MAP IN UNIT IV FILE,ADDRESS: LUIS' <br /> WORK PLAN DATED: -Z d- l b b� <br /> APPL.ICATIONACCEPTEDBY DATE ISSUED 3 AREA <br /> GROUT INSPECTION BY FINAL INSPECTION BY DATE O r� <br /> DESTRUCTION INSPECTION BY DATe <br /> COMM ENT S ICO N D IT I O N$: <br /> ACCOUNTING ONLY: AID o FAC A <br /> vcT coos Fide INFO JZCt7 RDM1TTti0 4C?4K a RECV D BY DATE ppRb(1Tf8P R�cn n IQtV01Cfi <br /> 350 —y►,, to 3 dg seat <br /> C+OT WG WAIVER TTERO UTHORITA SIGN PERMIT. <br /> ENCRO.VNMEtJT DOC <br /> EHO 2MI iV5V tACB) Yncu erity,T�rr <br />