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SAN JOAQUIN COUNTY <br /> LE- <br /> ENVIRONMENTAL HEALTH DEPARTMENT SITE <br /> 600 East Main Street, Stockton, CA 95202-3029 r `� I I:T ATION <br /> P Telephone: (209)468-3449 Fax:(209)468-3433 Web:WWW.si �[�LI,_ J IT IV <br /> WELL PERMIT APPLICATION j UL 0 8 2008 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISff Rn(X,:1f0EN 1 HI Ai Th <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This ap�TLie9ij�hll � iqeliance with San <br /> Joaquin County Development Title,chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department.��' <br /> 3535 E. Cherokee Rd Newton Road STOCKTON 95205 Assessor's <br /> 132-060-09 <br /> Well Location Cross Street City Zip Parcel# <br /> Property Kni htsen <br /> Owner Cecchini Cecchini Giovanni Address Po Box 52 City 9 Zip 94548 Phone# (925)754-2058 <br /> C-57 Contractor Test America Inc. Address 1016 E. Katella Ave City Anaheim Zip 92805 Lie# 819548 Phone <br /> Advanced GeoEnvironmental, Inc. <br /> Consultant/SubCntr Address 837 Shaw Road City Stockton Lie# 680227 Phone (209)467-1006 <br /> GIS Coordinates:X Y --W.2 55 Township Range Section <br /> WORK TO BE PERFORMED: <br /> ❑NEW WELUBORING(CPT GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER-) ❑DESTRUCTION(CHOOSE TYPE BELOW) <br /> ©SOIL BORING# B�0 ❑OVER-BORE DIAMETER <br /> ®WELL#VW-1,VW-2,VW-3 ❑PRESSURE GROUT <br /> ❑"OTHER GROUT SPECIFICATIONS <br /> COMMENTS: Soil Boring will be to approximately 100' the soil will be used for ozone Bench Scale Test. <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑MONITORING ®HOLLOW STEM DIA.OF BOREHOLE 8",12 1L]MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: 211,4" <br /> ❑EXTRACTION ❑AIR HAMMER/DRIVEN CASING THICKNESS SCH 80 TYPE OF CASING:❑STEEL B PVC ❑ OTHER <br /> ®VAPOR ❑MUD ROTARY DEPTH OF GROUT SEAL 71 <br /> TREMIE TYPE TO BE USED GAUGERS❑HOSE <br /> ❑AIR SPARGE/OZONE ❑PUSH POINT(GP OR CPT) GROUT SEAL PUMPED:❑Yes [3No (NOTE:MAXIMUM FREE-FALL DEPTH IS 30) <br /> ®SOIL BORING ❑HAND AUGER GROUT SPECIFICATIONS PORTLAND TYPE 11 <br /> ❑OTHER: El OTHER: APPROX.BORING DEPTH 100' ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (If YES ist 7irl tions in comment section) <br /> COMMENTS:vw-1(Extraction Well) 4"PVC, SCH 80, 0.030slot, screened 101-301, blank o'-lo' <br /> VW-2 VW-3(O servation Wells) 2"PVC, SCH 80, 0.030slot, screened 10'-301, blank 0'-10' 1 <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMEN RMITSV1AW1ZW�-- <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS <br /> I hereby c fy that 1 have pre this apppplication and that the work will be done I accordance with San Joaquin County Ordinances,Rules and <br /> R <br /> egul ons, nd all applica 6e1t rLa <br /> Si Title/Company ADVANCED GEOENVIRONMENTAL, INC. <br /> Print Name LAUREN CARDINALLI Date 7-08-08 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: 6/ <br /> d/ 35 - <br /> WORK PLAN DATED: %.el Q `!2 be <br /> APPLICATION ACCEPTED BY jEjS���AREA 46" / <br /> GROUT INSPECTION BY FINAL INSPECTION DATE <br /> DESTRUCTION INSPECTION BY DATE <br /> COMMENTS/CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE PERMIT/SERVICE# INVOICE <br /> MM[. <br /> Q 7—�•O$ R#4.5� <br /> C-57 WC Vol -WAIVER C57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC �✓ <br /> EHD 2M1 11/5/07 WELL PERMIT APP <br />