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f 0 SAN JOAQUIN COUNTY • FILE COPY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 SITE <br /> MITIGATION <br /> Telephone:(209)468-3449 Fax:(209)468-3433 Web:wWw Sigov ora/ehd <br /> h, UNIT IV <br /> WELL PERMIT APPLICATION <br /> I NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application ism de 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 Location 519 S. Stockton Ave Cross City Ripon,Street W Fourth Street Assessors <br /> Property pon, CA Zip 95366 Parcel# 25932025 <br /> Owner Nestle USA Inc Address 800 North Brand Blvd City Glendale, CA Zi 91203 <br /> P Phone# <br /> C•57 Contractor Gregg Drilling , Address 950 Howe Road <br /> City Martinez, CA Lic#485165 Phone 925-313-5800 <br /> Consultant/Sub Cntr!is BID Address Hyland Ave,ste zoo <br /> 3525 H y COStd Mesa LIC#778024 714-662-2759 <br /> 6381081.85 2090769.53 CIt Phone <br /> GIS Coordinates:X_ 3 x[77 Y �� /. _ Township 2S <br /> T 77T— P Range BE Section 29 <br /> WORK TO BE PERFORMED: <br /> ®NEW WELLIBORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER') <br /> ❑SOIL BORING# [I DESTRUCTION(CHOOSE TYPE BELOW) <br /> ®WELL# M- B an - B ❑OVER-BORE DIAMETER <br /> ❑`OTHER ❑PRESSURE GROUT <br /> GROUT SPECIFICATIONS <br /> COMMENT,Wwo wells to be installed, per Central Valley RWQCB-approved Work Plan- No access agreement required; <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ®MONITORING 12 HOLLOW STEM DIA.OF BOREHOLE 44 ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: 2 <br /> ❑EXTRACTION ❑AIR HAMMER/DRIVEN CASING THICKNESS Schedule 40 TYPE OF CASING:❑STEEL IN PVC ❑ OTHER I /t <br /> ❑VAPOR ❑MUD ROTARY_ 2- above <br /> DEPTH OF GROUT SEAL sa�g­u-_THEME TYPE TO BE USED❑AUGERS[]HOSE <br /> ❑AIR SPARGE/OZONE ❑PUSH POINT(GP OR CPT)_ GROUT SEAL PUMPED:❑Yes ❑No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> ❑SOIL BORING ❑HAND AUGER GROUT SPECIFICATIONS bentonite and cement <br /> ❑OTHER: ❑OTHER: APPROX.BORING DEPTH Both to 50 feet \ (� <br /> CONDUCTOR CASING PROPOSED ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE v 1 <br /> COMMENTS: ('it YES,list sPsafttmtions in cromment section) <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 _ irn.���- ^g-- Title/Company Project Manager, Environmental Cost Management <br /> Print Name Binayak Acharya <br /> Date November 16, 2009 <br /> DEPARTMENT USE ONLY ^ lob <br /> SITE MAP IN UNIT IV FILE,ADDRESS: <br /> o / L <br /> WORK PLAN DATED: <br /> APPLICATION ACCEPTED BY DA I <br /> I AREA <br /> GROUT INSPECTION BY FINAL INSPECTION BY r <br /> DATE lZ Z7��p�j <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 PERMITlSERVICE# INVOICE <br /> EHD28-01 1115/0](WEBI C57 LETT R OF AWC -WAIVER ffl # <br /> AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC <br /> EMD 2 <br /> WELL PERMIT APP <br />