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• • FILE COP ' <br /> San Joaquin County <br /> Environmental Health Department SITE <br /> 304 East Weber Avenue,3rd Floor,Stockton,CA 95202 MITIGATION <br /> (209)468-3449 Fax:(209)468-3433 Web:www.sjgov.org/chd UNIT N <br /> Well Permit Application <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR PROM DATE ISSUED <br /> Application is hereby mads to San Joaquin Covey for a permit to construct andlcr install the worn desafesa This apptapon Is meas In ow"ana wkh Sar, <br /> Joaquin Cony Development Tab,Chapter 9.1115.3 aria the Star4wds of San Joaquin Courcy Envkonmentd HeeM DepotrneM <br /> WELL Location,5756 Pa L:& croee stw g2nV r,b- c ty S� ap JI Zv P !oZ—2-X to / <br /> Dr�tIo2�w.( irl _�yap Gn9 �41 /tel/ <br /> C-87 CaNarEx AdAvae 5292 Pic t n�) _ZIP u& zzp onaa 9zL—x- a-� <br /> ConwN.ntrS �ZAc.-AA <br /> �las8tib pyT <br /> imcaus <br /> Pnnr91G7y�7w� <br /> 00 cooranates:x e <br /> ishlp DD (21.'13 - roa� <br /> Range Sectio' <br /> NEW WELL 1130FUI (CPT GEOP HYDRNCK RAND-AUGER,OTHERS p DESTRUCTION (dwoea type WloM <br /> eff'SOIL BORING* '1Jre Hn GYD,X1rI Nter(-50-AsarAp N 5 fF w 0 OVER-IME. DUMETER <br /> 0WELL 8 1— 41 jc' '+ 9mvdva�a pPRESSURE GROUT <br /> p'� -54016%- GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF VELE INSTALLATION TYPE CONSTRUCTION SPECIFICATNY/S <br /> p MONITORING p HOLLOW STEM DIA OF BOREHOLE 1 j p MULTIPLE CASINOS p MULTHEVEL WELL CASING DIA <br /> p EXTRACTION p AR HAMMERA)MVEN CASING THICKNESS TYPE OF CASING: p STEEL p PVC p OTHER: <br /> D VAPOR p MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED, p ANGERS p HOSE <br /> p AIR SPARGE/OZONE QrNSH POINT 9 or CPT)GROUT SEAL PUMPED: p Yes p No (NOTE:MA)aMUM FREE-FALL DEPTH IS 30-) <br /> ys'SOIL BORING p HAND AUGER GROUT SPECIFICATIONS <br /> p OTHER n OTHER APPROX.BORING DEPTH ' p BOLTTR TRAFFIC BOX BOX <br /> STOVE P PE <br /> CONDUCTOR CASING PROPOSED (d YES,get spec aborts In commert section) <br /> COMNEMTS, <br /> DI i / W <br /> 1iES Stvr*y (.)111 t& +OM Tb4 if bDM6U:, dtgtk thcln 30bg5 <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEME OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby cardly that I have prepared this application and that the work wlil be done in accordance with San Joaquin <br /> County Ordl anus,Rui and Regulations,and all applicable California Stab Law& <br /> r aZK5 T <br /> Y�Ov L ele�Co pany� ' Z C. <br /> Slarratl x ��__ � -- <br /> Prkt L1 �,1'Y`tYc(Yl�\ pate <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT N FILE,ADDRESS: S(D :n '�/a C�G✓�uJ�� <br /> WORK PLAN DATED: <br /> Application Acd By �✓ Des va Iae <br /> Grout hapactlon By Date IF Flml knpeWon <br /> Destruction IM way Date <br /> COMMENTS I CONDITIONS. <br /> ACCOUNTING ONLY: AID► FAC/ <br /> PE CODES FEE INFO AMOUNT REIaTrED CNECK 0 RECD BY DATE PERMR/SERVICE REQUEST• INVOICE <br /> gfo/ LD D - SRO O3 53 <br /> C-57 WC-WAIVER_ C-57 Letter of Authorization to sign permit_Encroachment doc <br /> EM 29-02-001 <br /> Erna <br />