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�°`'•'� SAN JOAQUIN COUNTY RECEIVED x••��•.oma -ter ENGIRONMENTAL HEALTH DEPARTNENT �l�N Q � •z ?�� LOP •:kw- 1868 Hazelton Avenue, Stockton, CA 95205-6232 UNIT Iv Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: www.s• I H WELL & BORING PERMIT APPLICATION 49T/SERVICES FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 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 Joaquin County Development Title,Chapter 9-1115.3. and the Standards of the San Joaquin County Environmental Health Department. Site Location 3105 S.El Dorado St. Cross Street IVY St. City/State Stockton Zip 95206 APN 175-120-28-00 Property Owner Cal Tank Lines,Inc. Address 3105 S.EI Dorado St. City/State Stockton zip 95206 Phone 209-466-3554 C-57 Contractor GreggDrilling Address 2726 Walnut Ave City/State Signal Hills Lic485165 Phone 562-427-6899 vlronmenta ervices,I Vista 760-639-3600 Consultan u�i n�r A�c�ress P.O.Box 1839 City/State Lic PG#6983 Phone Donan Environmental ervtces, nc. P.O.Box 1839 Vista 92085 760-639-3600 Billable Party Address City/State zip Phone GIS Coordinates:X Y CONSTRUCTION WORK TO BE PERFORMED: NEW WELL/BORING(CPT,GEOPROBE.HYDROPUNCH,HAND-AUGER,OTHER) ❑ SOIL BORING IDs N WELL IDs MW9 MW 10 ❑OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS 2 ®MONITORING )51 HOLLOW STEM DIA OF BOREHOLE 10" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS sch.40 TYPE OF CASING: ❑STEEL ®PVC ❑ OTHER _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL 49• TREMIE TYPE TO BE USED: $7 AUGERS ❑HOSE aPIPE _[I SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED IN Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) -lL is _❑INJECTION(i a.Air Sparge.Ozone)❑HAND AUGER GROUT SPECIFICATIONS Neat Cement 5% Bentonite _❑OTHER ❑OTHER APPROX.BORING DEPTH 70' ®BOLTED TRAFFIC BOX OR ❑STOVE PIPE COMMENTS: CONDUCTOR CASING[INo❑Yes:Casing Dia: Casing Depth Boring Dia: NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #OF WELL(S)TO BE DESTROYED ❑ OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT WELL IDs: ❑ PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE GROUT SPECIFICATIONS ❑ EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED: ❑AUGERS ❑ HOSE ❑ PIPE ❑ MUSHROOM CAP AT L?