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05/02/200B 09:46 9253130302 GREGG DRILLING PAGE 03 <br /> Dji �� -i <br /> I , cQ� ��r�n ��ewlla.r4•-�rt• i <br /> E l•• "r j (�I�L)U SAN, ./'a,4.v,k.1� ri.,'' UNTY <br /> VIRONMEi, f ;' D',, - <br /> y SCA N�( I-I C)E. r��`MENT SITE <br /> ' H� e6 East Main Street, S.00I ton,CAo5202-3029 <br /> ^r� MITIGATION <br /> T� Mdaw, (209)458-3449 Fax:(209)436-3433 Web:vrvvw.siaov,ora/ehd UNIT lid <br /> WELL PERMIT APPLICATION FILE <br /> NON-REFUNDABLE PERMIT FXPIRESL1-YFzAR FROM DATE ISSUED <br /> Application la hereby made to San Joaquin County for a permit 10 construct andlor Install the work oesefibed. This application is made In Compliance with son <br /> �Jooaagruiin County Development Tltta,Chapter 9-1115.3 and lho Standards of Sen Joaquin County Enyltonmental Health Ospartmeni. <br /> yYe PA T.t",-o`t�.ree p!'F�4 Aseessors <br /> cellon La?A, Fr...taap Rd_ Cross 51 eat y¢rr3�r_ City ��Zip 6 Parcel# +L (e►B2�ej <br /> Property g �i <br /> Owner ��yi7i0.t� �V _ Address ,3�TdAU5+rtk\ Id.50*City�s>t lNe IGS Zlp W070 Phone 916-el <br /> C.57 Contractor (' Address 990 �O e ,�, City/tQ r+;Ae o. ZipySi'�Llc ty� Pheno ? IS^ <br /> w-R.op tA�°°°r i <br /> ConauitanUSub Cr>tr Addra 'o0 E•Q1s1lSs �t�.�_ City �m U'I I U 'S5 ,It <br /> c a 37�Phona 510-� a-p7 $sea <br /> rqK;;�e- so- ITS <br /> GIs Coordinates:X 'Y Township _. Range Section <br /> W RK TO 8E PERFORMEQ: <br /> NEW WELL/RORING(CPT, OPROB YOROPUNGH,HANG AVG6R,OTHER*) ❑DESTRUCTION(CHOOSE TYPE UELOW) <br /> OL <br /> BORING# ❑OVER-BORE-DIAMETER <br /> WELL ilv ❑PRESSURE GROUT <br /> C1*OTHER _._ ..... GROUT SPECIFICATIONS <br /> COMMENTS:_1 np���p�t �4ri rtmd _ <br /> TYPE OF WEi L INSTALLATION TYPE. CONSTRUCTION SPECIFICATIONS <br /> Q MONITORING ❑HOLLOW STEM OIA OF BOREHOLE ❑MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA:._ <br /> ❑EXTRACTION d AIR HAMMERIDRNEN CASING THICKNESS TYPE OF CASING:0 STEEL ❑PVC 0 OTMFR <br /> ❑VAPOR ❑MUD ROTARY _ DEPTH OF GROUT SEAL TREMIE TYP410 9E USED❑AUGERS 0 HOSE <br /> ❑AIR SPARGE/OZONE woUSti Pot (QP R CPT)_GROUT SEAL PUMPED:®Yes ❑No (NOTE:MAXIMUM FREE-PALL DEPTH IS 20'1 <br /> SOIL eORINO 0 HAND AUGER GROUT SPEVFICATIONS _ <br /> (I OTHER: Q OTHER: APPROX,BORING DEP1Tm Q BOLTED TRAFFIC BOX OR,Q STOVE PIPE <br /> CONDUCTOR CARIN•0 PROPOSM) (tf 1'E®.11m epncl%Wlons In comment eaction) <br /> COMMENTS: <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS . <br /> I hereby certify that 1 h P a 1pla cellon and that the work will bo dons 1 accordance with San Joaquin County Ordinance%,Rules and <br /> Regulations, 11 a Call a a. <br /> Signed TRI./.company - l <br /> Prat Ns^?e f'�✓ Date 15: 2e- <br /> 6 DEPARTMENT USE ONLY <br /> 1 <br /> SITE MAP IN UNIT IV FILE,ADDRESS: D 2?-- ' S- H A� V,/a V 17 - <br /> WORK PLAN <br /> APPLICATION ACCEPTED BY � �t"r� '� <br /> r q DATE ISSUED 5" 8_AREA_� R <br /> GROUT INSPECTION 9Y V i G'{•rSri& 1,, Mt(tirlf "naA 5-27.0$ FINAL INSPECTION BY rn Y DATE 5.72 -08 <br /> DESTRUCTION INSPECTION BY _.DATE 1 <br /> COMMENTS/CONDITIONS: „Ac%/a 2 2 1'Z Geo A,ry,�e S o 1 Yl or <br /> ACCOUNTING ONLY:. AID#, FAC# <br /> PE c06E8 I FEE INFO AMT REMrTTED CHECK* RECV'D BY DATE PERMMSERVACE 0 INVOICE <br /> 350 r o SR#pa410 0 ! m 7 <br /> C•57 WC -WAIVER _. __ C57 LETTER OF AUTHORIZATION TO SIGN PER IT ENCROACHMENT DOC' <br /> END29-0111/5M117 WLL PCRMITAPP <br />