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02/06/2006 10 37 209468343"z EHU PAGE 02 <br /> WELL PERMIT APPLICATION FORM SITE <br /> /no F �.0 - MITIGATION <br /> C SAN .IOAQUIN COUNTY U NIT IV <br /> FTMENT (EHD) <br /> E5 3 24 6 ENVIRONMENTAL <br /> M 4 E WebEer,Third HEALTH <br /> , Stockton, A., 95202 <br /> I 30 (209)468-3449 <br /> F�PE�i����R��S"CK <br /> R ISSUIn NMplence,Ash San <br />' Applfcatlan la hRroby made to Satin JChgpter �County.s m-4ftSts dards of sanconstux t Joaquin iii Cal M Sn nmental�K*Wth Dapartmanf Wes <br /> JaaRutn County Developmentlltt,Ctrrap / 3� -607WE LocalsoD'w s- Gross 5treaxt s aty p�Parcal� -- <br />' O. �1r <br /> FtOP1gFC1'YOwnar � �� r 4 Addraess C� <br /> P <br /> car caMraaarl r� 1�.------ 'add EJcP <br /> horl.# <br /> Caassultans!t5ub Contra � drvs <br /> Cil®C:oOrdir+ttas X,„��- ,,Y <br /> ,'�evamthlp Rtnpe 0RW- LSar�lars <br /> p DESTFiUGTtON(choose type t>Gbw) <br />' VEW WE 1 BORW(i(CPT,OEdPR09B.HYDtiQPUNCH.NAND-AUfiEfi.OTHER') a Ova"ORE <br /> 17 SOIL OFUN*# + 13 PRESSURE GROUT <br /> pgWELL* Gar outspedfleat#ia / <br /> "her. <br />' COMMI=NSS: <br /> ' W'lL CASING DA-7 <br /> ALE MuLTtPLEcasiNG8?GYss0O <br /> OOLLOW STEM DIA OF a0RF <br /> '4 <br /> II EXTRACTION Q AIR IiAMMSRMRIVRN CASING THI0KN&$�e y� �E OP <br /> FRCASI"IYP&T4 BE USfsOp LiGERS HOSE <br /> OSE <br /> U VAPOR IS MUD ROTARY pl=PTii OP GRyOUT 3 �. <br /> a AIR SPARGE p PUSH POINT OROIJT SEAL PUIIAPED p Yes 4 (NQS 1 MAXIMUM FREE-FALL.DEPTH iS 30'} <br /> HAND GROUT SPECIFICATIONS��5 VBPIp[s <br /> 0 gOlt BORING (� -OLTM TRArmc sox w p STC — <br /> 0 OTHE OTHB APPROX.BORING DEM <br /> 00 PUCTOR 9AZING mapoSIzD4 —01 Y68.Itst spmItigoons hers)- <br /> `COt�INIIzi�TS <br /> NOTE: OFFSITE SORINCS RiwQUiRi= ACCESS OR ENCROACHMENT PERMITS, <br /> CALL.THE UNIT IV INSPECTOR 48 WORKIND HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS <br /> I hereby certify that I have pmpared this application and that the wom will be dons in aacordancia with San Joaquln <br /> County Ordinances,Rules and Regula ons,and all applsc>zble California State Laws- <br /> 6 <br /> .a1►ws3. <br /> T <br /> Signed <br /> elCompany. , <br /> Print Name E T g 5NDY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: <br /> WORK PLAN DATED: <br /> Ste Isenad <br /> Applleallon Accepted ay final Invection BY Osffi -- <br /> Gmut Imp"On By Date <br /> � <br /> Destrurtton ftusclon Date <br /> Ca'JIIRitiAE1IT8 f GpuptTlpHS' �l'`1 <br /> FACI=WINGONLY- AID# MAP* <br /> C4dF.S FFA INFO AMOUNT REIIISTI PJ, CH90KO R=o OY GATE PBRMrT!eFAVICER RIIIQU92T s INVOIC9 <br /> SOsf /Z�c7 �K- 2 !'� �S 12f C'rscraaaa:hmerlt daC 1/231 <br /> • C-57,x„ WC__ WAIVER, C-37 Letter Authorization to sign permit .� <br /> .. w 4-n a' 1 old* T 707 oz— zi c/o� <br />