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nor,1 (/ ZU0 11:41 11Jy4858773 SPECTRUM EXPLOR TION <br /> 08/17/2C05 11 :21 FA:; 41545906 WEST BAY BUILDERS PAGE 02 <br /> San Joaquin County <br /> ME COPY <br /> Environmental Health Department I SITE <br /> 304 East Webtr Avenue, 3rd Floor, Stockton,CA 95202 MITIGATION <br /> N-IF (209)468-3449 rax:(209)468.3433 Web: www,sjgov.org/ehd UNIT IV <br /> Well Permit Application <br /> NON-REFUNDABLE PERMMEXPIRES t YEAR FROM DATE ISSUED <br /> Application is hereby made to ban Joaquin County for a parmil to cm6WOt anrvor inotall the work deaudbed. Thls application is made in compliance with San <br /> Joaquin Co inty,Development Tide.Chapter 9.1115.3 and the Smoaard6 of San J0000 c4unry Environmental Hearin Department, <br /> r wELL LpCddOa 5 -40 �� Cross.�ilfeel• l A9ae660ra <br /> 1\v ��J0 �U. R City-Q2(J.�>-+a'�. TP l``L�.�ZP9raattl a41– 31U--�/�' <br /> PROPERTY <br /> Oxmor _Address Z S t:(/i Iry�iP PhOrtelC <br /> C-57 Conk actor ^•,_Aedrega (p$_ ST_icay, O LZIp Sm Lic 5-f22GP �9 �f6S—S3'•1(•2.- <br /> Consultor tlSubCntr / Address City Ling <br /> 013 Coord nates:X Y Township ange Sedlon <br /> WORK TQ BE PERFORMED; <br /> D NEW WELL I BORING (CPT,GEOPROBE,HYDROPUNCH,HAND•AUGEL:::O: <br /> VRCUTSP$CIFICATIONS�_. <br /> RUCTIN (ohoo9e We Wow) <br /> II SOIL BORING 9 <br /> II WELL •BORE DIAMETER RyV r g5pr <br /> II"har SURE GROUT <br /> COMMENTS: <br /> �'AE OF ft" L SALLATION TYPE CONSTRUCTION CIFIO <br /> B MONl7pRING D HOLLOW STEM OIA.OF BOREHOLE_ WELL CASING DIA:_ <br /> D OCTRA.(MON 0 AIR HAMMER/0RIVEN CASING THICKNESS TYPE OF CASING: D STEEL 0 PVC D OTHER: <br /> D VAPOR 0 MUD ROTARY CC"OF GROUT SPAL TREMIE TYPE TO BE USED: D AUGERS D HOSE <br /> D AIR SPfRGE/OZONE 0 PUSH POINT(GP or OPT)GROUT SEAL PUMPEO: Byes 0 No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> 0 SOIL ECIRING D HAND AUGER GROUT SPECIFICATIONS <br /> go THER: n OTHER APPROX.BORING DEPTH D BOLTED TRAFFIC BOX or D STOVE pips <br /> GOMMEN r3: CONDUCTOR CASING PROPOSED (d YES,Rel opedflcadons in cornmaM section) <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS, <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I he y'oertl, that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> CountOrdln ces, Rules and leg Itions,and all applicable Callfomla State LOWS, <br /> Signed x \. TRWCompanv 60, 5,0.,b, <br /> Print Nam, w.. i v� ..� <br /> Date <br /> DEPARTMENT USE Orll_�xe <br /> SITE M/1P IN UNIT IV FILE,ADDRESS: <br /> WORK I3LAN DATED: <br /> Applicada r ACCMted By Date Iss Area <br /> Grout lns:oWon By Data Ina Impedlon <br /> Desprualon Ir*Veglon B Data �� - •� <br /> COMMENTS I CONDITIONS: <br /> ACCOU 4TING ONLY: MEN <br /> AID>t FACA <br /> PECODES FEEINFO AMOUNT REMITTED C14ECKR REC'0 BY DAT PERMIT JSEFmCE RCQUWSTV INVOICF <br /> WC_-WAIVER_ C-57 Letter of Autharixatian to sign Permit_ _Endrddehtnent doh <br /> EFiD 19.01.001 <br /> aff <br /> 06/17/2005 FRT 11 vn rTVIev .,� — <br />