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E q <br /> SAILQUIN COUNTY PUSLIC:HEALTH SERVICES , <br /> ENVIRONMENTAL HEALTH DIVISION ; UNIT IV <br /> 304 E_Weber,Third Flodr,STOCKTON,CA 95202 <br /> y (209)488-3450 <br /> NON-REFUNDABLE PERMIT EXPIRES 1'YEAR FROM DATE ISSUED <br /> C(OlpyApplication is Hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compflance with <br /> San Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Public Health Services, Environmental Health Division. <br /> Assessor's <br /> Si;ellob Address 700 W. Linne Road crass street Ci(y, Tracy Parcel# <br /> OwnePs Name Prudential A9_ Investments Address 7208 N. Fresno Street Phone#(209)437-0180 <br /> Coniraclor SB & S Drillin Address 7756 Floradorano' Ur,-- C57-667662 Phone# (209)252-9460 <br /> Fresno CA 93727 <br /> Sob Contr2cor Address ? — Lio# Phone# <br /> EI: <br /> WORK TO BE PERFORMED t <br /> a NFlV WELL ISORING(CPT,GEOPROSE, HYDROPUNCH, HAND-AUGER,OTHER-) XX DESTRUCTION(choose type beicwj <br /> ' O SOIL BORING# ` <br /> Q OVER-GORE <br /> p WELL# PRESSURE GROUT <br /> COMMENTS: <br /> TYPE OF WELL CONSTRUCTION TYPE CONSTRUCTION SPECIFICATIONS <br /> Xj tvfON!TORlNG XX HOLLOW STEM DIA. OF BOREHOLE lviULT1PLE CASINGS?Q YES a NO WELL CASING CIA: <br /> U'EXTRACTIONo AIR HAMMEWDRIVEN CASING.,THICKNESS 1` TYPE of CASING: Q STEEL 'Q PVC (]OTHER: <br /> VAPOR i�! Q MUD ROTARY DEPTH OF GROUT SEAL" TREWE TYPE TO BE USED: (]AUGERS Q1-JOSE <br /> U AIR SPARGE Q PUSH POINT GROUT'SEAL PUMPED: 0 Yes Q No.(NOTE_ MAXIMUM FREE-FALL DE PITH 1S 30') <br /> Q SOIL BOP.ING i]-HAND AUGER APPROX.9CRING DEPTH Q LOCKING CHESTER BOX or 0 STOVE-RIPE <br /> D OTHER:lE CONDUCTOR CASING PROPOSEC1 (if YES, list specifications here)' <br /> Ic _ <br /> commENTS. See attached Well Destruction Work Plan- - <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS! <br /> i neraby certify that I have prepared this application and that the work will be done in 3=rtance with San Joaquin County Ordinances, State Laws,and Rules <br /> and Regulations of the San Joaquin County- Home owner or licensed agent's signature certifies the following: 'r terrify that in the performance ci'the work tr <br /> ,.vnich this perrnil is issued. I shalt not employ persons sub)eC.to WORKMAN'S COA4P5VSA CN Laws of California." Contractor's hiring or sub-ccntrac;ing <br /> signature certifies the f Mowing: "t certify that r the performance or the vgric for which this?ermit is issued, 1 she!l employ persons subject o WORKMAN'SCOMP_NSATION L s of Califomia." THE PPLICA T MUST CALL 48 HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS AT(209)488-3450.. <br /> Signed x Title. President Date 12/7/98 <br /> i I I I a ! <br /> . <br /> i !t- .11i <br /> 1L II �J:A , , - <br /> 1; DEPARTMENT USE ONLY <br /> Application Accepted By Date!ssued <br /> Gfeut Inspection By Date Final Inspection Sy r++ O IR! fr+91 Farelr :.. ate <br /> 1 <br /> Destruction;Insoection By ��� 1 Date <br /> CCMmENT8: .3 /ruc� 4/ <br /> " <br /> FAC# : <br /> SAF, <br /> i ACCOUNTING ONLY: A[D# <br /> i P1J6L C i4=AL7 y SF F v!(-.nxc t <br /> it • -_. - — :::nu 'r�.ntAL:',E't :rVet:'. <br /> 1I PE CODES FE INFO AMOUNT REMITTED CHECK#lCASH, RECEIVED BY DATE PE:RMIT!SERVICE Rkdut�T,AI:NUMBER INVOICE <br /> X90 2' I I I ODS Cid �/ SR# D 1 iU <br /> I <br /> Ur`EIT TV/LOl-98/MI � �a . .,�� •r}�,°'� :�' .`..,,;R , � 1 i.1 . . _ . . Y : <br />