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0�4R!ry SAN JOAQUIN COUNTY <br /> ORI (�INIAJ <br /> ENVIRONMENTAL HEALTH DEPARTIVItNT I L P <br /> y' •` SITE MITIGATION <br /> 1868 Hazelton Avenue, Stockton, CA 95205-6232 UNIT IV <br /> � •.- ;::.�;:P Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: www.sogov.org/ehd <br /> <<FOR WELL & BORING PERMIT APPLICATION RECEIVED <br /> FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED APR 0 3 2014 <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 c�rrg[�I' p � TM, <br /> Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health De p��I�V��Mf�EN—T[ <br /> Site Location Shipley Road Cross Street Humphreys Dr City/State Stockton zip 95203 P 5gY►1��/,%RMGES <br /> Property 209-946-0246 <br /> Owner Port of Stockton Address 2201 W.Washington St City/State Stockton Zip 95203 Phone <br /> C-57 Contractor Woodward Drilling Address 550 River Road City/State Rio Vista Lic #710079 Phone 707-374-4300 <br /> Consultant/Sub Cntr ERS Corp Address 1600 Riviera Ave Ste 310 City/State Walnut Creek Lic #879420 Phone 925-938-1600 <br /> Billable Party ERS Corp Address 1600 Riviera Ave Ste 310 City/State Walnut Creek Zip 94596 Phone 925-938-1600 <br /> GIS Coordinates:X 37.956562 Y -121.371508 <br /> 3?`1Ccc)a -/L/.37/7 <br /> CONSTRUCTION WORK TO BE PERFORMED: <br /> ❑ NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) <br /> ❑ SOIL BORING IDs <br /> ❑WELL IDs <br /> ❑ OTHER IDs <br /> TYPE&#OF WELUBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: <br /> _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER <br /> ❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE <br /> _❑SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) <br /> _❑INJECTION(i.e.Air Sparge.Ozone)❑HAND AUGER GROUT SPECIFICATIONS <br /> ❑OTHER: ❑OTHER: APPROX.BORING DEPTH ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE <br /> CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth: Boring Dia: <br /> COMMENTS: <br /> NOTE: OFFSITE WELLS& BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br /> _a#OF WELL(S)TO BE DESTROYED W-240,-241,-056,-150,-039,-177,-184,-030,-152.-153 ❑OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT <br /> WELL IDS: P 104,-113A,-1136,-119,-123,-128,-134,-139,-143,-112,-118, X❑ PRESSURE GROUT TO DEPTH OF 25 FT BELOW SURFACE <br /> GROUT SPECIFICATIONS neat cement ❑ EXPLOSIVES FROM TO FT BELOW SURFACE <br /> TREMIE TYPE TO BE USED: x❑AUGERS ❑ HOSE ❑ PIPE x❑MUSHROOM CAP AT L? <br />