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' 11/14/2003 14 29 2094683433 FIFTH FLOUR PAGE= 02 <br /> a Q LL PERMIT APPLICATION PQ � �RZIML <br /> Ul <br /> SITE <br />' SAN JOAQUIN COUNTY MITI�ZATiON <br /> $gyp - <br /> • 1 0 2003 ENVIRONMENTAL HEALTH DEPARTMENT(EHD) U'N!I IV <br />' EW IRONWENT 1'E4L7A04 E. Weber, Third Floor, Stodkton, CA.., 9520.2 — - - _ <br /> PERM1r1sE19VICES (209) 463.,3449 () CPT` <br />' NDIV-I2EI UNDASLE PERMTr EXPIFF�R 1 YEAR FR00VA-M ISSe1EIJ <br /> =qui l,on is hereby rrmda nt San.IpjLVt 9.11cmmfor 3 peraut io '' gtnict and/or install the work cWscdbed Thts appluaLon is made in=vitance mth Sari <br /> 7dt]iJ+A County Opti>ertf Tlle.Chapipr 9-Z 115.3 QW the Slazu ards of Sane Joaqulra County Emmortrmntal Health CWwrtment <br /> rEi!_ ocateote �(. Illi:l r,� <br /> Wo cess scree=t n city S ur,�C ►. �i� 9 g S /6 0 <br />' etvPERrr owner f' D, a. Address 13 t aty.5 + EI' ZIP7&Fno�e � 1 3 ; L� <br /> -57 c. ,trace, NSITv SD P Rc� IL4a " <br /> - n T-��9rSS9 �d3�hon #' 2.5 3t358oD r� <br />' ansykant l Sub Cats (2 Addtrss S w i � Ody S-1`a_r1{fnhirr �0, �7 PhoneJ# i d 7^ fOO fm <br /> 1IS Coordinates 7. 766?.�'l Z Y i 17S d 7'omstup Range _ _ Sealtan^ <br />' VORK TO BE QEIIMt MF& <br /> P4EW Wmj_jaoRING(GAT.GEOPROaE.HYUR Punt HAN�l C1'TJIERI) p DESTRUCTION(c=se type below) <br /> JMIL BORNG#CPT j G r� � I]OVFJ i-80RE <br /> :3thoe" c)A —'si-L_,a1NELL# —rout Specb=boms II PR$'SURFz GROUT <br /> YPE OF WELL INSTALLJI CONS"CMUCnON SPEClF1g4E TitxNS <br />' MONITORING U HOLLOW STEM Due.OF SCREHOLELZ,�n_MUL71PLE CASrNGS?R MUE 71-LEVEL?p WELL 0 SING 01A <br /> EXTRACTION 0 AiR HAiil MERMRlVEN WING THICKNF-SS �S(A TYPE OF CASING_ a STEF-L 0 PVC U O i HER- <br /> VAPOR 0 MUD ROTARY flEl:'M OF GROUT SF-!AL -V"D TREMIE TYPE tO BE USED {I AUC4 RS ;H HOSE <br /> 46SPARGE!Ozone_KFUSH POINT CRflUT SEAL.PumpEn $Yes 0 No (NOTr=: N AXIIItUM FREE-FALL I)EPTH lS 30') <br /> L BORING Q HAND AUGER GROI.3TSPECIFICATIONS_-_17D Ta :Suv&c-.c a fQ -ja. <br /> crrHER- - 17 OTHEP APPRQ.L BORING 04EP''3 H IZOII 8oL'F l=o F F 4FFIC 80x ar Q`7Q}1E;PIPE <br /> CONDUCTOR CASING PROPOSSEr? L{4 (.f YES,IFst s aaftabons here)— <br /> ;ZJ(`tI�$l~N75• <br /> rs tE4urr P Sc% I l <br /> NOTE: OFFSITE BOPINGS REQUIRE ACCESS OR ENCROACHMENT PERMIT S. <br /> CALL THE UNrt IV INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPEC'I TONS. <br /> hereby certify Ow I have prepare this applirateon and that the work vinic be done in a"ordance with Sa.i Jmquin <br /> ounty O Rules a Reguia#iorts, and ail applicable Caiiforma State Lags. A <br /> ynedx Titlel+<on�panY A or" A��d'iri . -eo �r nrerela� <br /> vet er 1 e r- Date`1 `7f— <br /> C�3 <br /> DEPARTMENT USE ONLY, <br /> ITE MAP IN UNIT IV FILE,ADD 5S: fr,�-J�+� A.A. } <br /> IFORK PLAN DATED' <br /> ipinoaton Accepted B Date+Issued � r � � _ AreaU <br /> out Inspackn By rats; _ - Final IsaspecOcn By I oat— <br /> �moUctunn IInsrmchhoon gy <br /> If <br /> MEN S I CjCfti •q Y <br /> %CC0UWnr4G ONLr AIL?# <br /> A&DI7E5 FEE INFO A14oi1tytT I -rm CHECK RECD BY DATE PEFilF!SFVICE RECIt1 ST i� t11VOtC> <br /> I57 WC -W RIVER C- -- <br /> raj l..izfifier of Autharizn#ion to sign pernafi 1=ncro+ichrnent Doc 8f29102 <br />