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ou dfan Joaquin County , FILE C P� <br /> x EnviMhmental Healy% Department SITE <br /> { 304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 MITIGATION <br /> (209)468-3449 Fax: (209)468-3433 Web: www.sjgov.org/ehd UNIT IV <br /> Well Permit Application 2007Fr6 _2 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED PH 1` S6 <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This ap/ `Sfm-o i <br /> Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental A;� y nce/nw/�ithn/San <br /> WELL Location %� East Cherokee Road Cross Street Newton City Stockton Zip 95205�Prce <br /> PROPERTY <br /> Owner cecchini. cecchini 6 Giovannoni Address 6 Northridge Court Antioch 94509 (925) 754-2058 <br /> City Zip Phone# <br /> C-57 Contractor Advanced Geoenviornmental, " 837 Shaw Road Socon 5 680227 <br /> �iddress d CitytktZip 9520Lic# Phone#(209) 467-1006 <br /> Consultant/Sub Cntr AGE Address 837 Shaw Road City Stockton Llc# 680227 Phone# (209) 467-1006 <br /> GIS Coordinates:X ,Y ,Townshi <br /> P Range Section <br /> WORK TO BE PERFORMED: <br /> ANEW WELL/BORING (CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER') 0 DESTRUCTION (choose type below) <br /> TSOIL BORING# 6 borings <br /> 0 WELL# ll OVER-BORE. DIAMETER <br /> Q PRESSURE GROUT <br /> p'Other GROUT SPECIFICATIONS <br /> COMMENTS: Borings are for part of DTSC investigation of former surface impoundment (landfill) <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> a MONITORING 0 HOLLOW STEM DIA.OF BOREHOLE MULTIPLE CASINGS G MULTI-LEVEL WELL CASING DIA:NA <br /> a EXTRACTION a AIR HAMMER/DRIVEN CASING THICKNESS NA TYPE OF CASING: 0 STEEL O PVC BOTHER: <br /> a VAPOR p MUD ROTARY DEPTH OF GROUT SEAL 8 Feet TREMIE TYPE TO BE USED: BADGERS p HOSE <br /> p AIR SPARGE/OZONE 9PUOSH POINT(GP or CPT)GROUT SEAL PUMPED: a Yes p No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> I;SOIL BORING OCHAND AUGER GROUT SPECIFICATIONS Neat cement <br /> a OTHER:_g OTHER APPROX. BORING DEPTH 5 to 8 feet a BOLTED TRAFFIC BOX or a STOVE PIPE <br /> CONDUCTOR CASING PROPOSED NA (if YES, list specifications in comment section) <br /> COMMENTS: Borings will be advanced using a Geoprobe or hand auger, whichever is more feasible at time of field work. Work is being <br /> performed as part of a OTSu-directed investigation. <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 OrdinanI d gulations, and all applicable California State Laws. <br /> Signed x_ Title/Company Vice President/AGE <br /> Print Name Robert Marty Date 22 January 2007 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE, ADDRESS: 3(p5S f 3(o ISS & b75C 2?-5p <br /> WORK PLAN DATED: 2Z.� 07 <br /> Application Accepted By �� Date Issued ';?-' S / Area Q 6 46y/ <br /> Grout Inspection By ate Final Inspection By Date <br /> Destruction Inspection By Date <br /> COMMENTS I CONDITIONS: <br /> ACCOUNTING ONL#INFOAM�OUNT <br /> D# FAC# <br /> PE CODES FEE REMITTED CHECK# PERMIT/SERVICE REQUEST# INVOICE <br /> 29 0� S �y'/4 / SR# �04�1e69 <br /> C-57_ WC=WAIVER_ C-57 Letter of Authorization to sign permit_ Encroachment doc <br /> EHD 29-02.001 <br /> 6/22/04 <br />