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oAp r , 4 . 2000 10 : 35PM'AX 916 4101 V ii' DRILLING INC NO - 1124 P - 2/23o2 <br /> Aar. 4. 2000010: I7P41t F,,,m TO ;No. 1123 PP. 2/2 <br /> WELL PERMIT APPLICATION FARM UNIT IV <br /> SAH JOAQUIN COUNTY PUBLIC HEALTH SERVICES <br /> ENVIRONMENTAL HEALTH DIVISION (PHS-EHD) - <br /> 304 E.Wabar, Third Elaor, Stockton, CA., 95242 <br /> (209) 4684449 <br /> NON•PF-F N A PCRMrT EXPIRES 1 YE► OATS ISSUED <br /> Application k heutgY made 10 San joaQvla County t a vermit lG Ccnatruct artily+inahn ata wort de 6i xd. t3ppliCation 6 mrde M compl,eRce wKr. <br /> 5an IgaaUin COUn+y mal opMeet Tltle-Cnapter 4.111 S.3 and the$w4dards U Sar+Joaquin County Puekc Health SONIGee,Enrilonmtntal t tcgiNh Oovii;oe <br /> WELL LocatIOnSyo-��d<+pt�E t+fr^C- GrpS55Veet #RCE S7C:ty4 iM-7NA�PZip ParceW 19.11 TIP-a <br /> PROPERTY Owner art t AndrCis r r�a s✓nc PIu +��_Cay _z;oQ �OPhontiA_ A S4r1 SS Es <br /> G51 CcnUauor +r-1 DiSc AOaress tAa. fox yl(p CITY Ifs - 7Jv LiiQrta90 Pnan,t z� //Jaya <br /> coMwltantlSob Cantrattor ton.�oC Aadresa �J'X.fr�K�e��tCiryS�cK>a-i;tit Ptwne:_. .731 -r/y <br /> GIs cootaia►tss•X Y_ — 7owesillp 1.[' Rrnge E 9eolan ..z.3 <br /> WORK TO K KFIFORNtEO <br /> Q NEW Wf1LI BORING I CPT,CCdPR091;,NTDROPUNCH.KAND•ALItFR.OTMER7 Q DEETRVCTIOONO��t type dCILC detow- <br /> V"L aORitvt3s <br /> 0 WILL i Q PRESSURIs GROUT <br /> r ' <br /> TYPE q11 VrEt_L 1 S N ON TRUCTION SPEST CATI <br /> QMONITORWr, aHOLLOWSTEM ot+a00UORCFiOLE MULTIPuaGSInt3S11jYQS OW <br /> NO ELtCASING'D1A; \f� <br /> IS EXTRACTION Q AIR HWMEi�FUvCN CASIf'{G Tti(CKNESS_._ __ TYPE Of CASING. a STEQt Q AVC D OTHER <br /> D VAPOR a MUO AOTARY bEPTH OF GROUT SPAL TREMIE TYPE TO BE USEt): D AVOCR5 QNOSE <br /> 0 AIR$PARUt D PU5M POINT GROUT SEAL PUWIED: Q Yts (I Nv (NoTE., MAXIMUM FRCE•FALL DEPTH IS 30') <br /> ❑SOIL BORING AtIAND AUGER APPROX.CORING IIEPT}I Q ROLTEO'TRAPFIC BOX or Q STOVE PIPE <br /> 0 OTtIER. Q QtHGR cof1DUCTOR CASING PROPOSECl? ef) I i(YES.tine e;r�2�lK el�o..s ne+rT. <br /> O <br /> CpsHMEt1T5: <br /> N E: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS <br /> I ltn[Cy C{+ttt�f lhii 1 hive praPatad lhlr app4catien arta,that ttse■.nrX wW 44 dent{n et�oo�l,nae wlth an.l�agvin t'A4Rp/pmhanu/.51yee�sw.a.end IRUCcS <br /> ana#IC4.10IIonS of IM San Josd.+in County. H&Tseov~Of wn7[d 49"Cs sivaiw•ceHlllata Inc raftwkg:'i c vly'that W Ot ptrroemir—07 u.r cif <br /> fa wwdh ws permit is w4ed,f shall not employ F-40-Ti tUofecf to WORKR/RS'COMPBNSArION Lz s of Ca/Uo-l--' =onlractora hi—S w wb- <br /> cortirwov aly+tatws cii"f 4s Inc tobowinp:-4 celTdr Inlf Ort Ih[parfwmancc or pt[work for v4iich INA pamd IS/jjVld,I SMAN OMP'Ot DW10+18 SIMOV f0 <br /> WORKERS'COMPFNSATION LAWS OtCali(4r-4C' <br /> CALL THE UNIT 1V INSPECTOR AS WORKING HR5 IN ADVANCE FOR ALL REQUIRED INSPE=0143. � <br /> �� V & IN Drilling, Inc. <br /> Sig+tea x TakJCuxrtPa"Y <br /> PnniN:arne Roberti E. 'ViCker D.te 4/4/00 <br /> MAP iiN tJN1T.`lV,.WRi�L P.'LAN;�DA, <br /> . ': ..N..-1.., fir,..-,n <br /> Q0EPAR7f4ENT WE ONLY / C , <br /> APRgIbR AyceDted By �Ci( Oate tee+,ed l Urea <br /> Govt InepeClStfn t3Y Dale Fall IMP4C ion El Oats <br /> oauroemen Inti yton$ Date f <br /> FE <br /> !AM;l <br /> )f PACS <br /> NT R£MIZ -- c►1t;cIC K iiEG'o RY DATt? Pl�isduT/±3EK1VlIC-Ef-"0EUEST tM/OICF- 1/?7 l u o <br /> 1�Igrzaor� <br /> 04/04/2000 TUE 11.16 [TX/RX No 59281 fR1002 <br />