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NOV-15-05 TUE 02:32 PM GRANS, INC, FAX N0, 3036654391 P. 02
<br /> S.7u .Ionguilt County _
<br /> ti Eng-iroltltlPat:ri ><le,T1rItI?epntltnent 51YE
<br /> `°. ^�• ;`� 304 FmCVVeLtr Avcuue,3rd Fbor.Stocktr:1 CA 55202 MITIGATION
<br /> ' 709 46S-3A+9 Fax:(209 +bS-3+3S ttte0:mnv,s ^uY.ox ehd UNIT IV
<br /> ;f,r:ctEit' Well Permit Application — '- --"- -
<br /> NON-REFdfIDABLE PERMIT EXPIRES 1 Yf..AR FROM DATE ISSUEO
<br /> AFJ ICJ6:n It 1lerdCy m,k!oSrn Jaag4lnCarty lora emit lc cGnslrca Serf tom:e•I'J,b vedEr,,i nan!,#1Joap ica:oalemade In co:ilpfaRCe L611:1tn
<br /> .IooJ.!n Cew1ry Po^+alc:J',ort TJ'a,Cn:,oter 5-1 s',5.3 and 1Ae Standards ci E3r•.b;pc M1:C:�J1y Erdrorn•,en;al Heaah DepxahenK
<br /> WELL Loc.d,on 2401 Mac Anhw Ddve ,ry Traev213.07050
<br /> PROPERTY 2 633-4268 -
<br /> Uvael Lc ring Foote COmoanV AdartCc, 2401 Mao Anhui Drive ^itp Trxov Lig 0537G_pho,, j ._,.�
<br /> C•57Contradcr,Caacado Drilling lnc.11111111111AdJltu 38320mec Circle CFJ^cho Cord ov Ig 9574'[ 717510 Fhp,aR tst6I 636-1167
<br /> Cmb:ulWntf Sib Gn7_,raLtQ,TLa05Y117,C� AQe,Ct363 Caplennlal Pkwy,Ste 21DLi;I,Louiavillo,G WE ph,ane#,,.(3D31 BG5-0300
<br /> GIS CCCI dAI:db"u'X_-••-IdI� 3n. , F. ,Y 417R,�20N ,TvnYlcai} Renntl „S'ee;'nr Land Grant
<br /> WORK TO BE PERFORMED:
<br /> &NEW WELL IBORING (CPT,siropo%os`e•th.'GR"-W'UNCH,Y.A?,O-AJG=ROTHER'I fiDESTRUCTIUIJ (IaO;CL,Pabe0x9
<br /> X 11 SOIL RO,i:;ci NoviRwRe. Ouomrii
<br /> 0WELL s—.M -,2Q MW-21 andGWVi_ OPRESSUREGROUT
<br /> D loom_•_•,-____.,,-_,,.- _ GR0'JTSPECI.9CA7l01,S
<br /> jyPE OF WELL IIJSTALLATION TYPF LCIA fiMIMC,>,[,{-e alIZ,tyTJ,-,lb(;•
<br /> 0IJ0KT0RIHy RHOLu-sst--1m 0IA,GFDOR?H0010" 0M'JL71PtFCALJIQS UMULTl-M'71ViELLCACINGDLA:_„„•.,__
<br /> q EK1.v4voN O AIR HAhA'�ER'ORI'i=PJ CADI;`107HICK:iE.3s' 71'FEOF CA.IMG: 0SiE_L LIPM pOTNcRI
<br /> gVArOR amtoROTARY DEPTHOFGROLITSEAL,•.Ut,,,.- TREMIETYrETOBEUSED: DAUGER, UHOeE
<br /> a AIR SPARGZ1OZd!'_ RFUCHPcorr(GP UCPT)GROUTSZ-AL PUNPED: 0Yro INo (NOTE:WJUht MFREE-FA LL DE PTHIS30')
<br /> 05OIL EOKII13 aKA!,lDAUGER GROUT SPECIFICATIONS Ter ASTM D5092 nJ?ASE' _nwmfnnY�'� C
<br /> 00Tr!ER' 00Tr :i-,_„-•_„--�„•,,,,,, AFPRJ:+:BOAlI1G D?Fl"r'4,• 25 it 08;fLT°rJ TRFFF:C 6Ux or 05T0":E PIpE
<br /> CONDUCTOR CASIII.PROF'0S9 No Ur YES,GoIOP`ul,exixlc l,l C IIvn lit tecta,)
<br /> COMMENTS;Two 2"product recovery wells to approx 2O ft,one 4"gradient control wall to approx 25 fl.in accordance with RWQCB approved plan
<br /> NOTE: OFFSITE BORINGS REQUIREACCESS AGREEMENT OR ENCROACHMENT PERMITS,
<br /> 48 WORKING,HOURS NOTICE REQUIRED FOR INSPECTIONS.
<br /> I haroby coltify that I hava prepared this application anti Lhat tho work will be lona In accordance with Sall Joayldn
<br /> County 0 t tiles and Regulations,and all Gpplic4le California(S�tatte Laws, T
<br /> DEPARTMENT USE ONLY
<br /> SITE LIAPINUNIT IVFILE,ADDRESS: yKot yNAts...�L.•v� 12'`^^"^ - 12.1�•(rr^r-1
<br /> WORK PLAN DATED: 4 13 I sem— —
<br /> A,r,':cai:nA•coep!cd By,�,�.-.,, �„�jpgp,� _ Date;lto�cd IL 1S OSS A.ro+
<br /> G:dlf.:I:f•(Rtii,.):1 Ei_-^��^^^^/o'✓� Dole 14cT Fra'imp0exi fiy,_.-. Colo _-_._,„-,••,.,,
<br /> Domc,'cn bngeclwn By Dasa
<br /> COMMEIII S f CONDITI0N6,.._—_ --
<br /> FCCOUd711VG O.\I.Y: AILLz F;,;,a _ _•� •,,,,.,_„
<br /> pECODEB� FEC INFtI A.MDUIJ7 REMITTED CHECK, RECDDY DATE PERMIT I SEROCE REQUEST# INVOICE
<br /> ZOO( , dU I•fI t qr (AX
<br /> fr'rs/os
<br /> t:-57_--•_ WC_-WALVE' _� C•57 Letter of Authorizal ion to s'isn permit Encroo0uncnt doq,_,,,-
<br /> �n±o-a:-act pp
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