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02/17/2006 13 47 2044683433 FIFTH FLOOR PAGE 03 <br /> ' a� " San Joaquin County <br /> `cte0 <br /> , x�' 't' :� Environmental Health De aJUNAL SITE <br /> 304 East Weber Avenge,3rd Float-,Stockton,CA 952 lGAT1ON <br /> 1 Ci <br /> _ (209)468-3449 Fax (209 46$-3433 Web www s�gav TA W�NIT IV <br /> ' Well Permit Application Fps 0 3 2005 9911 <br /> NON�tEFUMDAISLE PERMIT B%PIRES 9 YEAR FROM t]ATE <br /> AppGmt�grt es hereby made to San Joaquin County for o pamm to construct and/or inotall thew d sscri mrrtp4ante+villi San <br /> Jasgwn Cwnty Qevalaprnent Title.ChapW 9-1915.3 and to Standards of San Joaquin County Envinur <br /> WZULQC&*Mj2j50 Al. WL15010S y.Jah = rossStaast F &dwt ``CaySdbt den.rcp 95?�, Patc <br /> o <br /> PROPERTY <br /> � <br /> ' Csy cantrsdorlA}8s�'#�azr•-��Df IL, Aadreaa i� a 1'-e Ciilr/fns �' zip. BaSLlcx$19y w�. 7 .50 <br /> Corsuuant I sub Crt4 tato ���C CaL9.� ddress 31 ! rrs ctry (�Lik ic#' Sze _ Ptwno#7/Y9 6S- <br /> --�..� - <br />' GIS Coordilm es X .Y Tawnshp Ranga—Jrg,9121�- <br /> Section— <br /> WORK TO IN PEREQRMgw <br /> p NEW WELL!BORING SGAT a>=oPR0136 HYDRCPLINCH HANG-ALtc3ER CTF(") DSTRUCTIQtM! fdtooael3rpa� ) <br />' 0 SOIL BORING# gOWP-80RE DIAMETER_10 <br /> WELL# tMPRMUF49 GROUT <br /> R'Other GROU ST PEGiFiCA It <br /> COMMENTS, <br />' T�Q� GONS71r UGTlOr4�p�CIfIGAA�IDNB /f <br /> (MONITORING evMoi.LOw STEM DIA OF MORE rr 0 MULTIPLE CASINGS 0 MULTf LEVEL WILL CASING OW �- <br />' 1,1 EXTRACTION 0 AIR HAM AERIDRnIgN CASING T KlC NESS 2j" '{1_TYPE OF CASING Q STEEL XPVC (I OTHER:0 VAPOR ©MUD ROTARY DEPTH OF GROUT SEAL Q—/P3'0 TREMIE TYPE TO Br V=. 0 AUGERS p HON <br /> 13 AIR SPARGE(OZONE 0 PUSH POINT(GP or CPT)GROUT SEAL PUMPED- a Yes 0 No (NOTE. MAXIMUM FM-FALL DEPTH 13 34') <br /> ©SOIL BORING 0 HAND AUGER GROVY SPECIFICATIONS�Is,r-kl.�A Co....a�� <br /> �11 ORHAK n OTHER, APPROX.BORING DEPTH gd t - [I BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (i! YSS,ltat spedfkallam to ownment sectivnl <br />' NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 4E WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby cor*that I have pMpArea this appRcaMn and thirt the wont will be done in aGcordenre with San Joaquin <br /> County Ordtrlane&S, sand Rego and all applicable Caliigmia Slate l.awa <br /> r <br /> 9i�ried x- . MtWICol*W-Y jgkd ,A4 A"-+3f�Gr r3't-A�wf- G <br /> D-�z,-2--o � <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNrr IV RILE,ADDRESS: fZSv 1V_ <br /> WORK PLAN DATED: <br /> ApplKatlon Aooepted By Date Issued - 0 - Areca <br /> Grout lnwPodian Sy date Final Insp.cMart By Date <br /> t Dentnrotton Itis _ <br /> 09dID.a�� D°6° ice... <br /> COMMENTS!CONOMNS �^ <br />' ACCOUNTING ONLY AID# FACA <br /> Psi CODas 11122 6tlP0 A MOUNT R>ggrrTED CKI!CK A Rec D 6Y pATE PMUrr I WMICE REQUEST A rNYOICE <br /> c35dZ Way . r <br /> WC—NC-WAIVER— C-57 Let't'er of Authorization to sign permit acroadiment docv <br /> !>a~ID z9-oz�o t <br /> �z� <br />