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F ` SAN JOAQUIN COUNTY FILE COP Y Q�as111x �� z ^" ENVIRONMENTAL HEALTH DEPARTMENT LOP <� 600 East Main Street, Stockton, CA 95202-3029 SITE MITIGATION -aq •- Telephone:(209) 468-3454 Fax:(209)468-3433 Web:wwwsiaov.ora/ehd UNIT IV WELL & BORING PERMIT APPLICATION FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION / { NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ✓ J 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 Joaqui ouynty Development Title,.C�h/y/��tteer49-1115.3,and the`Standards of the San Joaquin County Environmental Health Department. city m Ripon Row s r'a'-1�-•� + l>Y � Engoachment Peen t Site Lo ion - Cross Stree. /e'/ z` ipon Zip 95366 APN Oc 2$qL E"OS Property T— !:.♦"— .. Owner City of Ripon Address 259 N.Wilma Avenue City Ripon Zip 95366 Phone 209-599-2108 C-57 Contractor Gregg Drilling Address 950 Howe Road City Martinez,CA Lic 485165 Phone 925-313-5800 Environmenlal Cost Consultant/Sub Cntr Management.mc. Address 3525 Hyland Avenue,Suite 200 City Costa Mesa Lic 778024 Phone 714-662-2759 Billable Party Envimnmental cost Management,Inc. Address 3525 Hyland Avenue,Suite 200 City Costa Mesa Zip 92626 Phone 714-662-2759 GIS Coordinates:Xiisuf There are 9 proposed CPT borings. See next two pages for location for each boring. - CONSTRUCTION WORK TO BE PERFORMED: t--- IKI NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) 4- 91 SOIL BORING IDs There are 9 proposed CPT bonngs in City ROW. Boring IDs are CPT-34 through CPT-42. 111� ❑WELL IDs Map illustrates location of USA Mark-0ut boxes.See next two pages for specific location information for each boring. ❑OTHERIDs TYPE&#OF WELLIBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 2 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: W _0 EXTRACTION:Vapor/Water 0 HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC 0 OTHER _0 SOIL VAPOR PROBE 0 MUD ROTARY DEPTH OF GROUT SEAL to Surface TREMIE TYPE TO BE USED: O AUGERS ❑HOSE 91 PIPE N _0 SOIL BORING 0 PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 Fr) _0 INJECTION(i.&.Air Soame.Ozonel❑HAND AUGER GROUT SPECIFICATIONS 5%bentonite and Cement mix _91 OTHER: CPT/hvdropunch ❑OTHER: APPROX BORING DEPTH -160 feet bps 0 BOLTED TRAFFIC BOX OR 0 STOVE PIPE CONDUCTOR CASING 0 No 0 Yes:Casing Dia: Casing Depth: Boring Dia:_ COMMENTS:CPT Iacal will be finalized based on uldilies as close as possible to Map loostil m Wodc Plan and the aeacbed fi ure approved by the Ci of Most,dutim a November 15 2011 field ince coon. NOTE: OFFSITE WELLS&BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) r� #OF WELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT W—ELL 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(>3 FT) FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances,Rules and Regulatlo nd all applicable CIlfo is Laws. .-- Signed ~�' o Title/Company Project Manager,Environmental Cost Management,Inc. y Print Name Binayak Ac arya Date November 28 2011 �t r DEPARTMENT USE ONLY G Q SITE MAP IN UNIT IV FILE SITE ADDRESS WORK PLAN DATED O APPLICATION ACCEPTED BY DATE ISSUED AREA Arjp GROUT INSPECTION BY FINAL INSPECTION BY DATE DESTRUCTION INSPECTION BY DATE COMM ENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO All REMITTED CHECK# RECV'D BY DATE SERVCE IRO# INVOICE REQUE�ST PR# 119 0 $125x 2S• pp /Mz 0 C-57 jA WC 14 WAIVER C57 LETTER OF AUTHORIZATION TO SIGN PERMIT—ENCROACHMENT DOC will �D�z