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— -APPL1Ga liUY fUM 1TeJJ:(rW mr rc-.,.,�� <br /> S;&AQUIN CQUM FuSUC HEALTH SERV M • <br /> YiRONNIE.NTAL HEALTH DIVISION ^ ^ <br /> . 3TDCX:ON. CAS —_ ` 0 \\ " ) , <br /> rp <br /> et•_PERMIT RES Q R fA09 047E 15511E7 '1V)"Ur:./ <br /> us(icacim is here by made to the San Joaquin Cshty for a permit to construct and/or irstatL ;he wort described. This appli,tatim is <br /> w.ace in coaoliaoce with San Joaquin Canty Dava(tTmenc Tial Chapter 9-1115.3 and the Standards of San Jcegiin Ca.-ity Public Reslth <br /> r'erviee5, °'rvirormentaL Health Divisic+. In�0_ /J <br /> 2 <br /> :ob Adcrass/or Apo L es city Stockton Parcet Site/AP1 /OZ ` <br /> ':vera Xarx Montgomery Ward Address 5400 Pacific Avenue Phone 1714/7736227 <br /> �trxterEnvironmental Audit, ;&g,, 1000A Ortega Way Lid „ <br /> 606348 Pheag714/632-8521 <br /> ,= Contractor V & yd Drilling Address Monier Park Place Lid 720904 Phone a 707/374-2815 <br /> Pin yieta , r A - <br /> 799 OF WELL/"P- & UV %ELL ❑ 20LACENENT LELL ,.i AYItTORING WELL 1 ❑ OTHER <br /> ❑ DESTRUCTICk Cl QJT-GF-SERVICE 'ELL Q ,VWMYSICAL WELL s 'Q SOIL 5=TMG <br /> IXSTALLATICH Cl W--' SYSTEM REPAIR ❑ C?,GSS-CCMMEC, AERAIR VAPCR EXTRACTION %X!L d c77Tni-6 <br /> Cl New ❑ Repair H.P. DEPTH PW SET FT. FIRST WiaR L_-VEL to VEW-1 3 <br /> OF PlA4PJ ' <br /> JI11 OED U?E TYPE DF WELL CG11377UCTIOX SPVMM1T10X5 <br /> 10' <br /> ❑ IMOUSTRIAL ClCPEH eOTTCN JIA. OF LELL IXGVATid DIA. OF CCSryUCTOI USIMG <br /> ❑ OCFLESTIC/PRIVATE , GRAVEL PACX/SI=__ 1'PE OF CASrWG/STS L/PVC PVC OIA. OF 'ELL CASING <br /> ' L /HUM IPAL ❑ DRIVEM OEM OF GRC1JT SEAL 30-55714-2 aneclFicATtcu <br /> G q OTHER cACUT SEAL FNSTALLD ST G,iCUT BRAND %AME <br /> NCNITCRIXG W=IT SEAL KWPIM- es � =CREE PEDESTAifici L gY oRll_ER: as ❑ Ho <br /> APPHOX. DEFid 60 ' LCCXIRG CiESTER 3ax/S.OVE PIPE <br /> 7ROPOSE'1 G3NS7RUCIIOMIDRILL'1fG NETMOD: AA ACTAtT_ AIR ROTARY AUGER. X C1eLe OTRER_ <br /> I hereoy certify that I have prepared :ms acct deaam and that in* wort wi LL at done in actnc <br /> 'rdae with San Joaquin Canty O.=i nanees, <br /> Stste Laws, and lutes and Regulations of tie San Joaquin County. He,e owner or tice^_ed a9ent's sismature certifies the follcuing: '•'. <br /> certify that in the perior,arce of the weri for.rich this pemit is issued, i sha(L me em Le'/ pefso ss Stbiect:to WCRYNAV•S C:7 —4SATLCM' <br /> Lays of California." Contractor's hiring or cacmcraaing signature c-Signature its "a following: [ certify ;hoc in :he per.'ormxa <br /> of tie Wer[ for which this Perron is iss_ad. ! «:all ercicy persons st*Tec: to =12KAX•S C=IPEHSATICM Laws of Ca liaarnia.` I:41 APPUCIXT <br /> MUST CAU 24' U76 IM 112VA-)IM FefF/AL�C�SF/il0IRE0 �1/Sa�ECI101cS AT(2091 4OS-IG23. Ctrtolece drawing at lower area provided. �+Q <br /> 1 <br /> X A � i( CpY / "I �!J'1 Title C�;Y1 � Jate� <br /> Si9neC tr �""C <br /> I Illllii I I IAL I illlllil <br /> III II { IIr fF PIN, i 4070TpoIllill I I I I I I I I <br /> II lilllllli sill II 17 1 <br /> DEPARTMENT USE ONLY <br /> Application Accepted Sy <br /> Inspection 3y Date a,. Ins -:ion ay- <br /> GroutOace <br /> ocstruction Impeccion 9y oate Coreents: <br /> ACLWUNTIN5 ONLY: I AIDS FACS I� <br /> PE CCDEZ I FEE IXFD AMOUNT REMITTED I CHE(7'=SH I AE{BVFa 97 OA I FS111V71SERYIC:Z REQUEST RUMRFit I INYCICE <br /> Pill, 16 <br /> I I I 1 <br /> • <br /> 1 17 <br /> { 1 I I I <br />