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'i NOV 1 0 2006 <br /> IlkSan Joaquin County <br /> R0NMENT.HMkj.onmen� Health Department SITE <br /> RMIT/SEWt Weber Avenue 3rd Floor,Stockton,CA 95202 MITIGATION <br /> (209)468-3.449 Fax: (209)468-3433'Web:Wwrw.sjgoV.orglehd UNIT til <br /> Well Permit Appfioatlon -- <br /> * NON-REFUNDABLE PERMIT MKPIM9 i YEAR FROM DATE ISSUED <br /> Applirallan Is hamby made to Son Joaquin County for a perrnit to oonxtruct andhsr install the wont desciloed. This appr"fion ie nlade in cornppanr*wim' San <br /> Joaquin County Development Tille.Chapter 1 111 a-3 and the Slandams of San Joaquin County Erwlronmental Health Depamnont., <br /> :s Aaseuao <br /> WELLLocatlon 3780 Freet Linne i oad `Cross Street 5 Ahern Rd City Tracy �p 95376 Paroshp`255-02-003 <br /> TY:w . <br /> oRQPIwR Donald sinalair 3780 West`LLinne Road Trac 95376 {2691 933-7517 <br /> Owner Address_ City Y ZIP Phone* <br /> TEG Rancho Cordova 706569 {51E) 853-6C},0 <br /> Cb7Contraaor Addiess119S0 Monier Bark.P1 CIty_ jp 5742 LlalR PhonerR <br /> ConavltantlSuhCntrGeological Technics Addrest 1101 7th Street Cry Modesto ud P (219)522-4119 <br /> 018 Coordinates:X` _y Townshlp Rsnpe 8edlun <br /> WORK TO BE PE8FQ5W& <br /> a NEIN WELL l 13OR NG (CPT,GEOPROBE,HYDROPUNCH.HAND-AVOER;VtMR-) 13DES' "'RUCTION (choose type Galovr) <br /> OIL BORING# 5 (SG-1 thru S6-_5),�L„b 0 OVER-BORE. DIAMETER <br /> L * — "` a PRESSURE GROUT <br /> D'Other GROUT SPECIFICATIONS <br /> COMMENTS: <br /> rfeE OF WEL INSI&LUON TYEF C0N8T1iLl17 ON 5PLWICATIQN9 <br /> D MONITORING D HOLLOW STEM DIA.OF BORE tiOLE`_ p MULTIPLE CARM136 0 MULTI-LEVET. WELL CASING D(A: <br /> D EXTRACTION p AIR HAMMEwL~RIVEN CASING THICKNESS TYPE OF CASING: D STEEL p PVC 11 OTHER: -- <br /> a VAPOR �, D MUD ROTARY DEPTH OF GROUT SEAL S�b t rREMIE TYPE TO BE USED: D AUGERS . 'OHOSE <br /> 0 AIR SPARGE)OZONE USH POINT(GP or CPT)GRO,UT SEAL PUMPEr): 11 Yea D No.(NOTE:'MAXIMUM FREE-FALL DEPTH.I9 30') <br /> 11 SOIL BORING 111 LAND AUGER GROUT SPECIFICATIONS E&a ' C y"6�i2 IE! <br /> a•; <br /> aOTHER- R UTMER APPROXI BORING DEPTFI 5 -6� a 80' LTED TRAFFIC BOX or It STOVE PIPE <br /> CONDUCTOR GA$tN0 PROPOSED_ (IC Yj$%IIst specillrxaons In comNmnt aa«lon,) <br /> tOMMENT8: ]see Attached NP dated August 18, 2006 for any additional.information <br /> NOTE. ;'OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. " <br /> 4a WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby cordly that I have prepamd this application and that the work will be done In aCCordance with San Joaquin <br /> County Ordinances,Rules and Regulations,and all appllcebie California State Laws. <br /> Slonedx �( _ TitlerCompamr TEG Northern California ]tic <br /> Print Name '' �e�.�. t�. I�;Ik;,,.So��' <br /> DEPARTMENT USE ONLY <br /> SITE AIAP.'IN UNIT IV FILE,ADDRESS: 3_FVd <br /> WORK PLAN DATED:_ _8, 1 yjv6 <br /> :3i <br /> Application Accepted By. aft Issued ,I !f 3/ob Aroa�a�t°L^ <br /> Groh IrwpecUon,By__ Lk n, .; Date Final Inspectlon By D®to <br /> Deatruaion Inspecton By Date <br /> OOHtltAEN7'S 7 cortlarTlONa: <br /> ACCOUNTING ONLY: AILIi FhC:a <br /> PEC CODES .',PECK INFO AmOutfr RF.W nED Cf 0?CK P�F.G'D BY DATE PEtRMIT ISERVICE RP-QU"T0 INVOICE <br /> a .moo <br /> C-57✓_ WC__•1NAIVEk_' C-57 Letter of Authorization to sigh permit, _Encr*46rijan4 doe_ <br /> EHD 29-01-001 <br /> 6=,V4 <br /> . 7,0 39VcA SOINHO31IVOI90-1059 LZZb1GOZ, 9S;:9I 900Zfi0/IT <br />