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FROM :ResvnantSonicinternatiana�� FRX NO. :5306662429ar•1 I <br /> Va4 <br /> 03/25/04 TM 1.0:31` 1rA.x 925 363 7275 TERRA'"JAG NOR CAL <br /> APR 0 2 2004 ' Av <br /> San Joaquin i3'County , ,,,-r X11 <br /> ENVIRC1�vf��,t.Iv , ti�I ;; ; <br /> Environdientai Health Department PERMIT/SPRVICES SITE _ <br /> 304 East Weber Avenue,3rd Floor, Stockton, CA 95202 MITIGAION <br /> (209)468-3449 Fax: (209)468-3433 Web: www.co.sAn joagttitl.Ca.tIS/ehd _� LL IT – <br /> __ - - <br /> ` — NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM GATE ISSUED <br /> Application Is h9reby made to Sen Joaquin County For a permit to construct and/or Instati the we&described. This application Is ItOde In compliance with San <br /> Joaquin County Dawciupment Tilie,Chaplet$-1115.3 and the Standard`:of San Joaquin County Environl7tental Health Department. <br /> WELL Location � ` — -- y s'rCL,Ir4�.� P Asacasars L{�} <br /> 7 L �(w.[ c > r� crass street cit Zip <br /> Zl <br /> PROPERTY ` <br /> Owger,�.�l.�era+a � i.'t• rldroe8,�.13. O�.S7�q�.� Gity r zlp�r�'��.F'hahe# <br /> C•57Contractor,Ray _ � _ y , a,� lt�.5 I.Llcff� Phono# <br /> L`en ti trant 1 Sub Cntrb'7r ' <br /> ,Address t <br /> �tfn,a.�nc s��Zty--C,F9�,Lie# �._ Phanel!! �iZS;ILI-13tx <br /> GIs Coordlnetee:X — �_. Y 17 rrirnshlp— .�Rattga�— — Secdon— <br /> WQRKT a QPMF-0; <br /> [I N1EW WgLL I BORING (CPT.GEOPROBE,HYr)R.DPUNCFI,RANO-AUGER,R,OTHER-) 0 DESTRUCTION (choose type,bel <br /> Olt.BORING 0�_�___�Z Jy� ��, []OVER•BQRE. DIAMETER. <br /> -- <br /> a WELL a —_� U PRFSSLIRE GROUT <br /> Q`Olhdr --- -_ Gt OLIT SPECIFICATIONS <br /> COMMENTS: - - <br /> IYP ti �► �-z 1N8TAL 4ATf0N Tyf -CONSTRUCTIONEc ECAT S <br /> MONITORINGQ HOLLOW STEM DIA.OF BOREHOLE MOLTIPLE CASINGS U MULTI-LEVEL WELL r:ASING DIA: <br /> D EXTRACTION 13 AIR HAMME RMRNEN CASING THICKNESS TYPE OF CASING: 0$TEEL p PVC O OTHER: ` <br /> 1)VAPOR 0 MLto Ro rARY DEPTH OP GROUT 9FAL, 1 TREMIL,TYPi:'TO BE USELi: U AUraERSS <br /> fI HOSE <br /> 0 AIR SPARGE10'ZONE PUSH POINT(GP or CP'nGROUT SEAL PUMPER: [)Yes No NOTE: MAXIMUM DEPTH IS 30') <br /> 9<0IL SORINC, a HAND AUGF.,R GROUT SPECIFICATIONS <br /> 0 OTHE M 0 OTHER`___ APPROX.bfJlgliVG DEf TIS ZSS� t <br /> BOLTED TRAFFIC Box or I]STOVE PIPE <br /> GOMIHENT3: <br /> CONOUCTOR CASING PROPOSRo �^(if YES,list specification:,in comment uecllan) <br /> '— <br /> NOTE: OFFSITE SORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING FOURS NOTICE REQUIRED FOR INSPECTIONS, <br /> I Hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, les a Reg dalt'iPis, and all applicable California Slate Laws. <br /> *jnao x w VLA V,, P �{� <br /> u` ,ftlkelLorlipanY., ' �• nLt <br /> Print Name / <br /> �--�--�• �....--_,._1741`. <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: <br /> WORK PLAN DATED. � p <br /> Application Accepted sy __ IsSueG <br /> Area. _ <br /> C3rovi Inspection F3y� �D:a- �FNtdl Insp®coon ey <br /> 131struC6on Inspactian B Data �`= �•—Ji'— ' <br /> COMMENTS I CONII)ITIONS: <br /> EACCOUNTINr,ONLY: AIDt1DES FE$INF0 AMOUNTREMITTED CHECK i! MEWD 8Y DATEPERMIT 1 SERVICE REStUEST# INVOICE <br /> � SR# <br /> C`57— WG__;;WATVI=R____ C-57 LPtter of Authorization to Sir?n Permit—Encroachment doe. <br />