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°/"5SANJOAQUIN <br />{ —COUNTY— <br />w,.;'d! Greatness rows here 9i�raP?� 8 <br />Environmental Health Department <br />SITE MITIGATION WELL & BORING PERMIT APPLICATION <br />NO eHIRUFRMITFXPIRFRI YEAR FROM DATE ISSUED <br />24 Hours Advance Notice Required ForAll Inspections <br />CALL (209) 9634897 For INSPECTIONS <br />Application Is hereby made to San Joaquin Countylor a permit to consbud andforinstall the vank described. <br />This application Is made In compliance vain San Joaquin County Development Title, ChaPter 9.1176.3, and the San Joaquin County Well Standards. <br />Job Addmss In Caltrans Slk26riglttofwaynextlo22A01SR26 Cllyi30to121p I.iuden,CA Phone <br />Cross Street C..APN next to 09134013 <br />Propestyonnee California Department of Transportation Phone <br />Address 180130th St CitylstaNlzip Sacromento,CA95816 <br />0-57 Contractor Gregg Drilling, LLC Weenaeli 1044456 phone (925)313-5800 <br />Address 95011osye Rd CitylstateMp Martinez,CA94553 <br />conanitanOsub•COnhaotor <br />la J <br />• '1'1� "Z <br />Lautx Gregg <br />UcanaeY _ <br />Address <br />/ <br />Urf "/ � .' <br />FAName <br />FAPE <br />CltylillobrIZip <br />(714)337.9726 <br />CONSTRUCTION WORK TO eE PER FORMEO:.'Note; ORslle BadngshVoXs Require Across Agreemanta w Encraedunent Pennita <br />TYPE OF WELUEONNO NUMBER pLS1Al1 nONTYPE CONSTRUCTIONS ECIFICAR0113 <br />■ nONlortwo 3 ■ IpLL01Yaral 110PARI IN 25-30 ■SOlTED1PAFFlCBOC ❑STOVEPIPE <br />Oeewcgon lnapecXon lfflfflffl <br />sell late <br />1866 E. Hazelton Avenue l Stockton, CElitomle 96206 1 T 209468-34201 F 209464-g03A0PL <br />la J <br />• '1'1� "Z <br />.p Addesa <br />Y+a.Mt.S' �-Isi+ FAV <br />® �.. a PRY <br />/ <br />Urf "/ � .' <br />FAName <br />FAPE <br />' � It <br />VlP fleaiawed BY - <br />r—ONunRECASiNG9ONUTREVELVIEU CALNOCU <br />El <br />EXTaACTION(VIPariatu) <br />_O <br />IWVAIMURNal <br />DIAOPSOREPOLE <br />CASBIOTHIMIESS TYPEoPeMO: CISTER. NPVC O OTHER <br />❑CL <br />SYAPORPNOOE <br />13 <br />BWROTARY <br />Oa: 2In Yq Oepec 2$�',Q_(S <br />❑SOSOPoO <br />Ci <br />INJECRONaem moa <br />1101)"MWR <br />mUXEiYPETOeEUSE.Cmlrq <br />WoVrSAOPTN ❑AuRa C111036 E PIPE <br />'PE SC•2 PEHINFO . <br />OnIPA <br />_ <br />❑ <br />mm__ <br />olumsEALPumpiat ■Yes ❑No g1oN;MWmvmiaelaTOpnga0nl <br />❑ <br />'IJ $152x j <br />Y >f, <br />A-21.003 <br />WoUrraFKA CAT10H9 10 hof <br />PVC slotted then max e(20 ft PVCblank <br />t5EW5OLe0RiN01oa <br />A 21-001 <br />A•2I <br />A0 <br />Oeewcgon lnapecXon lfflfflffl <br />sell late <br />1866 E. Hazelton Avenue l Stockton, CElitomle 96206 1 T 209468-34201 F 209464-g03A0PL <br />la J <br />• '1'1� "Z <br />.p Addesa <br />Y+a.Mt.S' �-Isi+ FAV <br />® �.. a PRY <br />/ <br />Urf "/ � .' <br />FAName <br />FAPE <br />' � It <br />VlP fleaiawed BY - <br />• t SLT.•)' 't( <br />IWoAcnatDab U <br />VLLJlr <br />❑CST <br />0DSrAW&U0011x GPMbSynPaaR <br />❑Woluh Cora ❑IYo5Nl CompWYra ❑firromTmlalPmY <br />1vxirriAin 6M1 LeadAPpod ❑IJP <br />COMMENTSICONDITIONSt �{I a , /1�+)l'M I <br />Oct r�� a Well 3'(<A"VwtCLs <br />Wp TVPE <br />'PE SC•2 PEHINFO . <br />REMITTED <br />CHECK >r ftECV'lD BY DATE! <br />'6.' larRUPPENM1774 <br />INVOICEY <br />Permit <br />'IJ $152x j <br />Y >f, <br />�. W �d(� <br />y� <br />/2V <br />. <br />tWVY�A)v�/ )�9(o�vytyolr9fehd <br />exoEsolestsxl .�T 1� is��%t'S `1 7 1�� <br />coM.� I Yrq��'i-iu�t <br />Na ie�t,,-ev i'v1 �v;+fie <br />l� p • <br />