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• °Aa`•'•t" SAN JOAQUIN COUNTY <br /> • FILE COPY <br /> r ?�' •4c <br /> r. ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE <br /> . 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3449 Fax:(209)468-3433 Web:wimmsiaov.oro/ehd MITIGATION <br /> UNIT <br /> LrFOR� <br /> WELL PERMIT APPLICATION vE ll —�-1b <br /> Former NestleFacility NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 2— <br /> Application <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 compliance with San <br /> Joaquin County Development Title,chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> Well Locatiol33g Industrial Ave E Fourth Street Assessor's 1 <br /> Cross Street pity Ripon, CA Zip 95366 Parcel#_ 259380 <br /> Property <br /> Owner California Freight Sales Address 251 E Fourth Street City Ripon, CA Zip 95366 Phone# 209-599-5418 <br /> C-57Contractor Gregg Drilling Address 950 Howe Road Martinez, CA 485165 <br /> City Lic# Phone 925-313-5800 <br /> environmental coec <br /> Consultant/Sub Cntr Nanagemenc Inc Address 3525 Hyland Ave,Ste 200 Cit, Costa Mesa Lic#778024 Phone 714-662-2759 <br /> GIS Coordinates:X 37.738 Y -121.122 Township2S BE 29 <br /> Range Section <br /> WORK TO BE PERFORMED: VE-11 and VE-12 <br /> ❑NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER`) ®DESTRUCTION <br /> El SOIL BORING# <br /> El WELL# ®OVER-BORE DIAMETERAt least 4" greater <br /> ❑PRESSURE GROUT tan OD of casing. <br /> ❑`OTHER GROUT SPECIFICATIONS Per SJC ordinance Code <br /> Section 9-1115.6 <br /> COMMENTS: Will attempt to popsicle wells VE-11 and VE-12 Will overdrill d grout if unable to popsicle the wells. <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: 4" 4 <br /> r�r ,., <br /> ❑EXTRACTION ❑AIR HAMMERIDRIVEN CASING THICKNESS TYPE OF CASING:❑STEEL ®PVC ❑ OTHER CIq <br /> ®VAPOR ❑MUD ROTARY DEPTH OF GROUT SEAL 8. <br /> TREMIE TYPE TO BE USED❑AUGERS❑HOSE <br /> ❑AIR SPARGE/OZONE ❑PUSH POINT(GP OR CPTL_GROUT SEAL PUMPED:❑Yes ❑No (NOTE:MAXIMUM FREE-FALL DEPTH IS 30') <br /> ❑SOIL BORING ❑HAND AUGER GROUT SPECIFICATIONS <br /> ❑OTHER: ❑OTHER: APPROX.BORING DEPTH 26.5' ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (it YES,list sPscifimtlons in mmment section) <br /> COMMENTS: Well completion log attached; Access Agreement in place and attached <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 I accordance with San Joaquin County Ordinances,Rules and <br /> Regulations,and all applicable California Laws. <br /> Signed t���J +a Title/Company Project Manager, Environmental Cost Management <br /> Pdnt Name Binayak Acharya Date December 20, 2010 <br /> DEPARTMENT USE ONLY��y,. <br /> SITE MAP IN UNIT IV FILE,ADDRESS: <br /> WORK PLAN DATED: <br /> APPLICATION ACCEPTED BY DATE ISSUED AREA �,,� <br /> GROUT INSPECTION BY FINAL INSPECTION ® T D DATE�dt�// <br /> �/ <br /> DESTRUCTION INSPECTION BY DATE <br /> COMMENTS/CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMT REMITTED CHECK 9 RECV'D BY DATE PERMIT/SERVICE# INVOICE <br /> 9D �yL S / 2L SR# <br /> 57 W -WAIVER/ C57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC <br /> E D '/I/ ] EB) �IY <br /> ,\ WELL PERMIT APP <br /> �� l <br />