Laserfiche WebLink
11/16/2007 12: 18 9253136302 GREGG DRILLING PAGE 03 <br /> IYIJv-1O�GI!1VJ r 11 41 �HrIbK t P 1707 935 6649 P.02/85 <br /> �. San Joaquin County <br /> Environmental Health Depart m SITE <br /> y 600 East Main Street, Stockton, CA 95202-3 MEN �"[I�1ITIGATION <br /> (209)468-3449 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> UNIT IV <br /> _2 NOV Well Permit Application 19 2007 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DNMEINT HEALTH <br /> Application iG hereby made to San Joaquin County for a permit to descn4C tW�*# made In compliance with San <br /> Joaquin County Development Title,Chapter G-1115,3 and the Standards of San Jo9quin Courrty Environmental Health Dep nt. <br /> 5/04N n rI Ie W AefSAssors <br /> WELL Localilon_7-7D&(Y)orl-Ii►M <T- Cross StreetdZrn.hCity Sf,rk#.N Zip Parcal# 'tt+-lam , <br /> PROPERTY <br /> Owner744 Irpj <br /> r Address City S 1< Zi► I pherat,� &jQ2 Lt& Tb <br /> C-5'Conlrat for Cr s n u1t- IpRtNL :6 PS no*Q Z E '313- pb <br /> Consultant/Sub C"-- Address `q 4- 911JA V-A City So,0emaLie* PnoneA ?O T � Y$SO <br /> Of. SUIMp-Lao <br /> GIS Coordinates:X Y I awnship Range Section <br /> YYQRK TO BE PED,FC MED_ ' <br /> p NEW WELL/BORING (CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER') AESTRUCTION (choose type below) <br /> 0 SOIL BORING* D OVER-BORE, DIAMETER <br /> 0 WELL# 'PRESSURE GROUT <br /> a'Other GROUT SPECIFICATIONS ^ <br /> COMMENTS: 'r \ 4 G — s C r <br /> TYPR OF WELL INSTALLATIQN TYPE CONSTRyoat1 aeggFICOONS <br /> 0 MONITORING D HOLLOW STEM DIA,OF BOREHOLE_ 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: <br /> 0 EXTRACTION p AIR HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: D STEEL p PVC D OTHER: <br /> D VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAQ_ TREMIE TYPE TO BE USED: D AUGERS 0 HOSE <br /> D AIR SPARGE/OZONE 0 PUSH POINT(GP or GPT)GROUT SEAT.PUMPED: 0 Yes 0 No (NOTE: MAXIMUM FREE-FALL DEPTH IS 301) <br /> a SOIL BORING 1]HAND AUGER GROUT SPECIFICATIONS <br /> 0 OTHER: Il OTHER APPROX.BORING DEPTH D BOLTe0 TRAFFIC BOX or 0 STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (If YES,astspecifications in comment section) <br /> COMMENTS: <br /> NOTE; OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS, <br /> I hereby cett,ty that I have wapared this application and that the work will be done In accordance with San Joaquin <br /> County Ord, nd Re ns,and all applicable Califorrlla State La <br /> Signed 711wCompany. <br /> Print Name <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS:l?ro 1 r� <br /> WORK PLAN DATED:)] , �c-�0 1 <br /> Appllcstion Accepted By ij K Date Issued/`��/G� Area <br /> Grout Inspection By Dot a nal Intpection By pate <br /> Destruction Inspection By Date -7 <br /> COMMENTS/CONDITIONS: ^' S 0. <br /> ACCOUNTING ONLY: AID# <br /> FAC# <br /> PE CODES FEE INFO AtNOUtrT REMITTED CHECK* REC-D BY DI�T6 rT SSCRVICE T# INVOICE <br /> (� I oo <br /> C-57 WC_WAIVER_ C-57 Letter of AvthorlZation tc sign perrnit E�1MCnt dee <br /> 9/1112007 <br />