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• h • FILE COPY IN <br /> s o <br /> San Joaquin County <br /> i Environmental Health Department SITE <br /> v 600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br /> (209)468-3449 Pax: (209)468-3433 Web: www.sjgov.org/ehd UNIT IV <br /> 4 �P <br /> -Fo Well Permit Application A�— - <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED I- `"'� <br /> Application is hereby made to San Joaquin County for apermit to construct and/or install the work describetl. This application is made in cam lance with San <br /> Joaquin C�u t Development Title,Chapter 9-1115.3 e Standards of San in County Environmental Health Department <br /> E. HARDING WAY Assessors R O W <br /> WELL Lo a ion toss Street City STOCKTON Zip 95204 Parcell##q <br /> PROPERTY ��5 Stockton p 95204 ,'O J 9 <br /> Owner City Of Stockton Address Zi Phone# <br /> 0-57 Contractor BOART LONGYEAR Address 510 5TH STREET City,COLUSA Zip 95932 Lic#694686 phone# 562-906-1960 I <br /> Consultant ISub Cm,SECORINTER. INC. Address 3017 KILGORE RD CityRANCHO Lic#NA Phone# 916-861-0400 i <br /> GIS Coordinates:X'121.29465, VA <br /> 649790y__37 770,4203603 Township 1 NORTH Range 6 EAST .Section 3 <br /> WORK TO BE PERFORMED: <br /> $1 NEW WELL/ BORING (CPT,GEOPROSE, HYDROPUNCH,HAND-AUGER,OTHER-) a DESTRUCTION (choose type below) <br /> a SOIL BO IMG - ,an a OVER-BORE. DIAMETER <br /> R W ELL# a PRESSURE GROUT <br /> a"Other GROUT SPECIFICATIONS <br /> COMMENTS: DMW-6,DMW-7,DMW-8, will be advanced using a sonic drilling rig Encroachment Permit#71688,Revocable#07-25W <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> YJ MONITORING a HOLLOW STEM DIA.OF BOREHOLE.8_25 a MULTIPLE CASINGS a MULTI-LEVEL WELL CASING DIA:2 INCH <br /> 1]EXTRACTION a AIR HAMMER/DRIVEN CASING THICKNESS SCH.40 TYPE OF CASING, a STEEL )0 PVC. a OTHER: i <br /> a VAPOR a MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: a AUGERS a HOSE <br /> a AIR SPARGE/OZONE a PUSH POINT(GP or GPT)GROUT SEAL PUMPED: RYes a No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> g SOIL BORING a HAND AUGER GROUT SPECIFICATIONS <br /> U OTHER: 5tOTHER.SONIC APPROX.BORING DEPTH 75 FEET BOLTED TRAFFIC BOX or a STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (if YES,list specifications in comment section) 3 <br /> COMMENTS: During advancement,soil samples will be collected continuously using a 20-foot core barrel. i <br /> i <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> i <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, Rules and Regulations,and all applicable California State Laws. <br /> Signedx`"`'*=..- "'-y""" Title/Company SECOR INTERNATIONAL INCORPORATED <br /> Print Name. MICHAEL SPERBER Date <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE, ADDRESS: /& E. GvP A <br /> WORK PLAN DATED: Lid <br /> Q <br /> Application Accepted By _ <br /> Date Issued Area } <br /> Grout Inspection By Date Final Inspection By Date <br /> Destruction Inspection By Date <br /> COMMENTS I CONDITIONS: <br /> ACCOUNTING ONLY AID# FAC# j <br /> PE CODES FEE INFO AMOUNT REMITTED CHEC # REC'DBY DATE PERMIT/SERVICE REQUEST# INVOICE 1991 <br /> 350 MuJ 89. 2, e.Qet, I 8 SR# Orj3obv i <br /> C-57_ WC -WAIVER C-57 Letter of Authorization to Sign ermit_Encroachment do b� <br /> 9/11/2 oz-ool WEB /�_ <br /> 9/11/2007 /� W <br /> i <br />