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{A�ltt�, � • San Joaquin County • <br /> — <br /> ,�; Environmental Health Department SITE <br /> {"] 304 Fast Weber Avenue,3rd Floor.Stockton,CA 95202 LITIGATION <br /> h` (209)468-3449 FAX:(209)46&3433 Web:www.s <br /> Jhov.o rg/ehd UNIT IV <br /> ' Weil Permit Application <br /> NoN.RIPMI ABLE PERMIT EWWJF3 t YEAR FROM DATE OWED <br /> JosquinAP0cCok hereby made M Tan Joaquin Courgy for a DsmiM ro ooraettct arxYa htdal els twrk OeeCaUad. Thk appNmllon b made In <br /> Joagofn County DevdopmeN ZNS,Chapter 91118-.3 and the Standards crew Joapidn cm*awk xurrnyt Heaat pal, contMbnoe��Sen <br /> WELL Loco" 230 Intlusbid Avamr. 1 aeea=m <br /> 95366 <br /> PwaBtPROPOwry <br /> DO U td d (.d rt Sand yr„a P D 60V 3 GS cay Ripon 0 95388 <br /> --� Pnaloa- <br /> c-et Comndw 1 A�raee <br /> Gaye <br /> ComuRaA/sae Cmr_ ECM �dnwis 680 Baker Street Costa Moen <br /> -----� Ctly _Ioe phay (714)862-2789 <br /> INS COW(INION:X <br /> Y-------,_,Tftn"" Roney <br /> Section <br /> x NEN+WELL!BORING (cPT,cEowzaeE.HYDROPUNcw,wwaAtxlER,oTw� 0 DESTRUCTION (diwea tyre below) <br /> X SOIL BORING* <br /> o WELL N B OVER-BORE, DIAMETER <br /> O')Mar 0 PRESSURE GROUT <br /> COMMENTS bWr= GROUT SPEpFICATIONS <br /> ano <br /> lied, P!Megn g000d Map <br /> TY�OF WE � <br /> B MONITORING g HOLLOW STEM DIA.OF BOREwOLE; 0 MULTIPLE CASINGS B MULTI-LEVEL WELL CASING lll�; <br /> B EXTRACTION u AIR HAMMER/DRIVEN CASING THIClWF�B --- <br /> B VAPOR B MUD ROTARY TYPE OF CASING: B STEEL B PVC BOTHER! <br /> DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: 0 AUGERS <br /> OSE <br /> B AIR SPARGFI07.ONE X PUSH POINT(GP OrCPT)GROUT SEAL PUMPED: u Yee 0 No (NOTE:MAXIMUM FREE-FALL DEPTH IS 301) <br /> X$OIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br /> 0 OTHER,-_____j OTHER APPROX,BORING DEPTH Varies.No table BOLTED TRAFFIC ( w Q STOVE PIPE <br /> comemmS. lyorirtoa wit! PROPOSED (M yM.eat Vsdflodlom in oommenl seodon <br /> ) <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> wtlfy that <br /> have Prepared"lis <br /> CountyOrd Ordinances,tRu est n Regulations,and Bit applicaWtion and that SCaftrnla Stab e work WIN to done <br /> accordance wfth San Joaquin <br /> Print Neme <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV PILE.ADDRESS_ <br /> WORK PLAN DATED:}3 la 1 <br /> Gtboedion Hy ate is l l I "7 An.e lal <br /> Dateof <br /> lnapecStMt <br /> n Data <br /> COMINOM I CONDITIONS; <br /> ACCOUNTINGONLY: AIOR <br /> FACS <br /> PE CODES PEE INFO AMOUNT NEMITTED CNECK• EREC087YE0M;ATEZPERMrT/6ERYIcqRlOUEBT• rNYOICE <br /> �1 o l 7,� 6-3sR <br /> C-57_ WC=WAIyER_ C-57 Letter of Authorization to sigh t <br /> EHD29902-WI pI^mit Encroachment QoC_ <br /> d2Z,pd <br />