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7 • San Joaquin County • <br /> Environmental Health Department S <br /> 304 East Weber Avenue,3rd Floor,StocktonMITIGATION <br /> SITE <br /> ,CA 95202 Mi f7 ITE <br /> "It'J.9 (209)4%3449 Far:(709)468-3433 Web:www.sjgov.oJg(ehd UNIT II/ <br /> X6.1 # <br /> Well Permit Application <br /> NON.REFuXoAALE PERMIT EXPIRES 1 YEMt FF406 DATE RMED <br /> Mparadiorl is twe "Oft to San Jo"Uh Colmlr br a Permit to comped wow hbi Sw wort deeabed. This anAknow is made in compliance Mth San <br /> Jos Wb 00t M Devdop(not TWO,Cheger e-1116.3 and 1M SWIdarde of San Joagdn Cmwt,Swkxwn rw Hupp pspaM»m. <br /> WELL Loco" 230IndwhielA� /Goa C�,.. Ripon m g53B8 P�� fi�1 � <br /> PROP <br /> Ripon <br /> Owrw <br /> ry�e erase -t W I�Ur'�P�- RIPon <br /> cpr L VASS 'Ktdrrs* (W)SW2108 <br /> C-67 CanVadw kn t Add <br /> Cls m <br /> C01100NOM/Sub Cna• ECM 060 Baker street Ce M <br /> A.." -----------_....,Cib' "r k1 phniee (714)882-2759 <br /> lM8 CoormnaAr*:X Y w <br /> ,Taerap RpWSection <br /> WORK TD BE P9tErIRYRM <br /> X NEW WELL!BORING (CPT,GEOPROSE.HYDROPUNCH,HAND-AUGER,OTNER� g DESTRUCTION (dlaoea type�lOw9 <br /> X SOIL BORING* _ <br /> AMETER <br /> g'Othw 0 PRESSURE GRO <br /> GROUT SPECIFICATIONS <br /> COMMENTS A t <br /> W 0=0 800 5ftQdmd-Man and table, <br /> TYPE OF WlLr YISLLAT126 TYPE COMBTRUOTIDM$PE@IF1C� <br /> 0 MONITORING Q HOLLOW STEM 01A-OF <br /> 0 EXTRACTION 0 AIR HAMME iVEN •" 0 MtM.TTY E CASINGS 0 MULTI-LEVEL VC CASING DUI; <br /> CASINO THICKNEBa TYPE OF CASING: 0 97EEL Q PVC 0 OTHER: <br /> 0 VAPOR 0 MUD ROTARY DEF"OF GROUT SEAL MEMIE TYPE TO BE USEC; GAUGERS <br /> Q HOSE <br /> 0 AUR SPARGEl OZONE X PUSH POINT(GP or CPT)GROUT SEAL PUMPED: 0 Yee 0 No (NOTE:MAXIMUM FREE-FALL DEPTH 13 3W) <br /> X SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br /> 0 07IiER' D OTHER APPROX.BORING DEPTH YwIK See tab* i BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> COYMEMM' Wil PROPOSED (H YES.Eat eped6oa6om In comment section) <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORI KING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby cwft that i have prepared this spplicanon and that the Work will be done In accordance with San Jo"uin <br /> Coutrty Ordinances,Rules and Regulations,and all applicable Calpomht Stab Lame. <br /> SWMd Yy_ j &A:n� TMIYCmpeny <br /> Pent <br /> DEPARTMENT USE ONLY <br /> SITE MAP MAP IN UNIT IV PILE,ADDRESS:_?3 <br /> WORK PLAN DATED-Appikebon <br /> A0oWAd� D.»leveed <br /> D"IrGroUvdbnl tlM n Inspction By Dab r lto"1. FYW IneMC6M1Date <br /> BY 11 <br /> gpection <br /> Comhow e I CONDIT10Me: <br /> M07`47 <br /> : A100 <br /> FAC* <br /> ApgUNT R8"n'TC-0 CNECK• RECDBY DATE PIRaRTISERVICEREQUESTa WOICE <br /> $�� 133acf �- S/I/off sR 5oS(o <br /> C-57_ WC WAYVEIt_ C-57 Letter of Authorization to sign permitEncroechttleNtY doe <br /> F7102902.Odt <br /> &72nN <br />