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0 1 . • FILE COPY <br /> o San Joaquin County <br /> Q y Environmental Health Department SITE <br /> " 600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br /> (209)468-3449 Fax: (209)468-3433 Web: www,sjgov.org/ohd UNIT IV <br /> �a <br /> 0 Well Permit Application ,, • 014 �S <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED '1,1,� <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 co W ncewith San <br /> Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> ALLEY NORTH OF HARDING CENTER STREET Assessors <br /> WELL Location Cross Stree STOCKTON. zip 95204 parcel# <br /> PROPERTY <br /> Owner City Of Stockton Address City Stockton Zip 95204 Phone# <br /> C-57 Contractor-BOART LONGYEAR Address 510 5TH STREET city COLUSA Zip 95932 Lic#694686 phone# 562-906-1960. <br /> Consultant/Sub CntrSECOR INTER. INC. Address 3017 KILGORE.RD. Cit RANCHO Lic#NA <br /> Y RD Phone# 916.661-0400 � <br /> GIS Coordinates:X-.12129465,649796Y 37.96770,4203603 Township 1 NORTH Range 6 EAST Section 3 <br /> WORK TO BE PERFORMED: <br /> )1 NEW WELL 7 BORING (CPT,GEOPROBE,HYOROPUNCH,HAND-AUGER,OTHER-) D DESTRUCTION (choose type.below) <br /> a SOIL BORING# D OVER-BORE. DIAMETER <br /> D WELL# DMW-.U D PRESSURE GROUT <br /> a'Other GROUT SPECIFICATIONS - f <br /> COMMENTS: DMW-9 will be advanced using a sonic drilling rig Encroachment Permit#71690,Revocable#07-26W fj <br /> r <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> $MONITORING D HOLLOW STEM DIA.OF BOREHOLE 8.25 D MULTIPLE CASINGS a MULTI-LEVEL WELL CASING DIA:21NCH <br /> D EXTRACTION D AIR HAMMER/DRIVEN CASING THICKNESS SCH.40 TYPE OF CASING: DSTEEL A PVC D OTHER: <br /> D VAPOR D MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: D AUGERS D HOSE <br /> D AIR SPARGE/OZONE B PUSH POINT(GP or CPT)GROUT SEAL PUMPED: DYes D No (NOTE: MAXIMUM FREE-FALL DEPTH IS 301) <br /> D SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br /> D OTHER: ItOTHER SONIC APPROX.BORING DEPTH 75 FEET BOLTED TRAFFIC BOX or D STOVEPIPE <br /> CONDUCTOR CASING PROPOSED (if YES list specifications in comment section) <br /> During advancement,soil samples will be collected continuously using a-20-foot core barrel. <br /> COMMENTS; 9 P Y 9 <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS, <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <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 /> '-v -•"-`"' SECOR INTERNATIONAL INCORPORATED <br /> Signed x � Title/Company <br /> Print Name MICHAEL SPERBER Date <br /> DEPARTMENT USE ONLY p i <br /> SITE MAP IN UNIT IV FILE, ADDRESS: 6• <br /> WORK PLAN DATED: G <br /> Application Accepted By .Date Issued / / Cl Area <br /> Grout Inspection By D e Finai Inspection By Date <br /> Destruction Inspection By Date <br /> COMMENTS/CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK# REC'D BY DATE PERMIT SERVICE REQUEST# INVOICE <br /> SUI v 3r o sR# py-3D�,Z <br /> C-57_ WC_-WAIVER_ C-57 Letter of Authorization to sign permit_Encroachment doc_716 Qa <br /> EHD 911//2007 1 WEB i1_ 410:7- W <br /> 9/11/2007 ��'f! <br />