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0 0 <br /> U.N. SAN JOAQUIN COUNTY <br /> Z. <br /> ENVIRONMENTAL HEALTH DEPARTMENT SITE <br /> 600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br /> Telephone:(209)468-3454 Fax:(209)468-3433 Web:www.s gov.org/eh UNIT IV <br /> WELL PERMIT APPLICATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with San <br /> Joaquin County Development Title,chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. Assessor's <br /> South Argonaut St Cross Street Charter way city Stockton Zip 95206 Parcel 9 16320008 <br /> 1819 <br /> Well Location-- ne#916-991-44Sl <br /> Property City City_ <br /> Zjp95851 Pho <br /> Owner John TaylorFertilizer Address PO Box 15289 <br /> 3894 Railroad Ave Yuba City Zip 95991 Lir# C-5-1 694686 Phone# 530-674-2033 <br /> C-57 Contractor Boart-Longyear Address City_ <br /> 14th St., Ste 400 City Oakland Lic#_Phone 510-285-2700 <br /> Consultant/Sub CntrGeosyntec Address 475 14th St., — Range_Section — <br /> GIS Coordinates:X -121,304941 37.931 83 ,Township <br /> WORK TO BE PERFORMED: C]DESTRUCTION(CHOOSE TYPE BELOW) <br /> HAND-HUGE �HEW <br /> NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH, []OVER-BORE DIAMETER <br /> [:]SOIL BORINGft n PRESSURE GROUT <br /> n <br /> WELL# GROUT SPECIFICATIONS <br /> IN-OTHER QEY 4 Installation E]EXPLOSIVES DETONATING CARD <br /> ----------- <br /> COMMENTS: <br /> WELL INIT ATION C 0 N 5MjUUWSPECIFICATIONS <br /> TYPE TYPE OF. _ALL _ TYPE DIA. 8" MULTIPLE CASINGS[I MULTI-LEVEL WELL CASING DIA:2' <br /> El MONITORING ❑HOLLOW STEM TYPE OF CASING:[I STEEL (K PVC 0 OTHER _ <br /> Ej EXTRACTION C]AIR HAMMER/DRIVEN CASING THICKNESS O�20311 TREMIE TYPE TO BE USED 0 AUGERS IS HOSE <br /> 0 VAPOR ❑MUD ROTARY­---------- DEPTH OF GROUT SEAL 751 <br /> []AIR SPARGEJOZONE ❑PUSH POINT(GP OR CPT)_GROUT SEAL PUMPED:IN Yes C]No (NOTE:MAXIMUM FREE-FALL DEPTH IS 30') <br /> 0 SOIL BORING ❑HAND AUGER GROUT SPECIFICATIONS Neat Cement Grout <br /> OTHER: Sonic APPROX BORINGDEPTH 70'.. to 851 BOLTED TRAFFIC BOX OR []STOVEPIPE <br /> list specifications in comment section) C::14 <br /> 0 OTHER: CONDUCTOR CASING PROPOSED lif YES, <br /> COMMENTS:. <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT-OR ENCROACHMENT PERMITS <br /> I <br /> —48 WORKIN�;-HOURS NOTICE REQUIRED FOR INSPECTIONS <br /> I hereby certify that I have prepared this application and that the work will be done I accordance with San Joaquin County ordinances,Rules and <br /> Regulations,and all I pli e lif nia Laws. Title/Company._Staff Engineer, G eosyntec Consultants <br /> Signed <br /> Date July 30, 2010 <br /> Print Name Lisa Kullen <br /> DEP kRT =-NTUaLP­N­LY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: U <br /> z' <br /> 04wc" ""( --711I <br /> WORK PLAN DATED: -z- <br /> APPLICATION ACCEPTED BY DATE ISSUED J-30"/I AREA, <br /> FINAL INSIDE DATE <br /> GROUT INSPECTION BY TION BY <br /> DESTRUCTION INSPECTION BY DATE_--.-- <br /> COMMENTS/CONDITIONS: AA LA) <br /> ACCOUNTING ONLY: AID# FAC It PERMITISERVICE# INVOICE <br /> PE CODES FEE INFO AMT REMITTED CHECK# RECV'D Y DATE <br /> ILCA(2 1 .vC, \/I-W-)- S-D (D SR# <br /> 606 3 <br /> 0 SIGN ERMIT -j.,— <br /> ENCROACHMENT DOG <br /> C-57_WC --WAIVER _—C57 LETTER OF AUTHORIZATION T WELL PERMIT APP <br /> EFID 29-01 10/28/09 <br />