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09/08/2005 10 23 FAX 9166792900 URS-SACRAMENTO-GO 1a002/005 <br /> 09/01/2005 10; 35 2094663 EHD PAGE 03 <br /> San Joaquin County <br /> Environmental Aeaxth Department SITE <br /> 304 FW Weba Avenue, 3rd Floor,SwckwL6 CA.95202 MITIGATION <br /> • (209)468.3449 Fax: (209)469-3433 Web:WW WAjg0V-OrW hd UNIT IV <br /> Well Permit Application <br /> NONJ2EFUNPABLC UPIRCS 1 YF=r-WM OATA t"UFP <br /> Apotuahun is heruty mode go Son Joaquin utony Por a prmmLLto C(mnR4 endre•IrWO rhe wont dracnead, Ttlla.ppllral;on Is node In vartpYanee With sen <br /> Jpagyn County OwMop"Tea,ChMftr 9-11'15,13 V4 the Standards M Sen J"e W n Cour'W d""'ronmontel Hearth DepellRwrt <br /> a120-q0 S. /fAALAd RD. QARnOMP- 4 °RAf"-OP 7 59 <br /> <43&03Z0 <br /> wElLoaeAz �yL7jp <br /> IsooY/ D o AAR <br /> O er lir1.�7 v�-t . ereY e�- G� 1�'�iKR -T City <br /> amuaasnt i sub aur dR S Colo cedr�s�S o pharef <br /> C7 Contractor aXlLi-44- 3&3z7a &7MJ; M7 <br /> rnrnDs 11�•-�'7 9-3eo0 <br /> as ooaPdtnord&x�136�3 Y 2l 3o�arb Ts•arer P RAn6e Sedan--___ <br /> eee e: <br /> EW WELL t ETORWC6 (CPT,G2OPRDSE,HYCROPUNCH,HANG-AUGER.OTHIIRh O DE$TRIICI10N (ehDOq(TPD bOby) <br /> �I34RINb s °Q pRREEMP.5 c OUT R— J <br /> M Gl GROU'1-SpFCIFICAT10N$ <br /> COMMENT& <br /> LIn INSTA6CM T'(PE CCNSTonemny SPIWIFIt:A Ra �/n <br /> 70ftING °MIO iow MT.M DL4 OF 60RpIOUS /�l�'�)(��MU-"L-IIPLE CA91NM xMLLMAZML WELL GAMNO DI/c•T - <br /> 0 p�ppCTfON 0 AIR HAwEwDj;4vFJN Gan tiG THi[]KNEei6 ' ePE OF CASING: °VIIEL )(PVC °OTY,ER; <br /> °VAPOR A,MUO ROTARY DEPTH OF GROUT SEAI.�MMIE TYPE TO BEED <br /> US ' ]]AUGERS <br /> °H06E rrt�` <br /> °AIR 8FARON OZONE Il PUSH POINT(GP urCPT)GROUT SEAL PLUM:Ryes °NO (NOTE:NAXINIUM FREE-FALL DEPTH IS 30) <br /> Q SOIL MORINO B HAND AUGER GROUT SPECIFICAT ONs Tc 7aND Ae <br /> °OTHER: - JI OTHER� IWPRC;L CORING D °BOLTED-RAFFIC Box or OTOVS PIPE <br /> CONDLiCTPn If1vLG PRgPO5EG 'yo of YL,Ad spanl9latans m rumina sedan) <br /> GONVIEWMI 17'C�� >( EIti1iUJ JT�AtQ <br /> NOTE: OFFSITE BORINGS QUIRE AC ESS AGREEMENT OR ENCROA01IMIEW7 FaRWTS, <br /> 48 WORKING HOURS NOTICE REQUIRED Few INVECTTON9. <br /> I hereby eerflty that 1 have prepared this application and mat the work will be done In accordance wHh San Joaquln <br /> County Ordina .Rules and Repulstlorw,and all applleabla C.aWuzria S:µ'• <br /> �„ra � TaWConlpany Q,oi'tzr' K as coeP <br /> PemName��/C1i'r�rJ A� <br /> Dfie-ARTMENT USE ONLY <br /> SITE MAP IN UNIT N FILE,ADDRESS- <br /> WORK PLAN DATED:�C i/ tt/ ✓ ' 1� D e <br /> App WOOM AOMPI d 9care 16nUetl�,..,1 1121 C S� _ 12 -7 -- <br /> Grod ramcaOn BY_ s.P l) OaorL_(b � D FInBI Irepoc6on DY Data <br /> Ceauaion Ins cyan DAM <br /> COMMENTS ICONOMDNS• <br /> ACcOUNTINO OKY; AIDe FAC& <br /> PECOOES FEEINFO AME)UNT r1EMIrW4 CNnCK& REO"�B'! r}ATt? PERM[Tl S�NVICE PEDUEaTe INVOICE <br /> L O`� Y vs �7, Q t2 > SRO U2)> �n � <br /> C-57 wr_WATVM_ a-57 Letter of Auft wization to bion Winit—E-EaOcchmeenf dnc_ <br /> &=4 <br /> E®/Le mod tit? IaO e96P5eb5Zb zb:9T 9e6L/eT/L0 <br />