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onssaln r: SAN JOAQUIN COUNTY ORIGINAL • 868 ENVIRONMENTAL HEALTHART Hazelton Avenue, Stockton Dq 9520 MENT d" . Telephone:(209)468-3147 Fax:(209) ckton 33 952 Lop Web6232 SITE MITIGATION WELL & BORING p aMN'S� OXa /Bhd u FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS PPLGA 1T ONS AND REMEDIATION Application is herebyNON-REFUNDABLE PERMIT EXPIR Joaquin Count made to San Joaquin Courtly for-an'- a ES 1 YEAR FR M DATE ISSUED Y Development Title,C P j l'R to construct Chapter 9-1115.3,and the Standards Of the San Joaquin County Environmental Health Department. «antl/or install the work descdbetl. This application is made In compliance with San Site Location '403 Navy Ddve Property Cross Street Tillie Lewis Ddve Owner Manuel Toledo City/Slate Stockton.CA Zip 85206 163-32t}�Z G.G. Address 2403 Navy Drive APN �� j/11/rr C-57 Contractor Gregg Dn 8 Tes' Inc Gty/State Stock.CA Zip 95206 phone 208.843.1777 —e Address 850 Howe Rd consultant/Sub Cntr Cardno ATC City/Slate Martinez Lic 485 phone 925.313.5800 Address 1117 Lone Palm Ave.,Suite 201 B Modest,C/. Billable Pa Cardno for Mr.Toledo City/State Lie 95351 phone tog-578 2221 Address 1117 Lone Palm Ave.,Suite 2018 Cil /Stale Modesto,CA GIS Coordinates:X 037.93780 Y-121.32524 y Zip 95351 phone 209.579.2221 CONSTRUCTION WORK TO BE PERFORMED ❑SOILOILBORING IDs ❑NEW W BOR (CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) El WELL IDs ❑OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE_ ❑MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vaporl Water ❑HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: 0 STEEL 11 PVC 0 OTHER _O SOIL VAPOR PROBE 0 MUD ROTARY DEPTH OF GROUT SEAL TREMOR TYPE TO BE USED: 0 AUGERS ❑HOSE ❑PIPE _O SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED:0 Yes 0 No(MAXIMUM FREE FALL DEPTH IS 30 FT) _O INJECTION(1 a Ar Spzrae.Ozone l❑HAND AUGER GROUT SPECIFICATIONS _O OTHER: ❑OTHER: APPROX.BORING DEPTH 0 BOLTED TRAFFIC BOX OR 0 STOVE PIPE CONDUCTOR CASING 0 No 0 Yes:Casing Ola: Cuing Depth:_Boding Dla: COMMENTS: NOTE: OFFSITE WELLS&BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORT(TO BE PERFORMED: : DESTRUCTION METHOD:(CHECK ALL THAT APPLY) I I;-r #OF WELL S TO BE DESTROYED r 17 OVER-BORE DIAMETER OF 8 INCHES TO DEPTH OF 3D FT G� WELL IDs: MW{ ,MW-2,MW-3,MW-4, MW-5,MW-6,MW-7�G-I�.�=r�3,'I❑, PRESSURE GROUT TODEPTHOF 29 FT BELOW SURFACE vr1;1/1S GROUT SPECIFICATIONS neat cement grout slum. S-b qab yo /K/yyl .(!MW❑EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED:O AUGERS ❑HOSE ❑PIPET O/j❑MUSHROOM CAP AT(>3 FT) FT BELOW SURFACE COMMENTS M V be---" r-CirOULed All other wells will be Dverdrilled 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE)FOR INSPECTION APPOINTMENTS I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances,Rules and Regulation (en all apJp ice I Callfomia laws. Tide/Company Branch Manager/Cardno Signed / Pdnt Name J! ne Homsey Dated I/ 1 DEPARTMENT USE ONLY TTT SITE MAP IN UNIT IV FILE-SIT ADDRESS 2 YU 3 N�3y y fly/ S 1�r177iy WORK PLAN DATED C 2c" DATE ISSUED AREA APPLICATION ACCEPTED BY J Ye Y�K�ru�m -/O-r 5� GROUT INSPECTION BY W6k; Iver Jvl___L_ FINAL INSPECTION BY til LZ R'LCt�ir�Ws� DATE, l7•IS DESTRUCTION INSPECTION BY tI,Gina. I��%�' '' — �' DATE `I /5 - COMMENTS/CONDITIONS: - yS G QI✓d'FYu ACCOUNTING ONLY: AID# FAC# SERVICE RO# INVOICE PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE REQUEST PR* 35'v2 $ oX l30o Cor. SR# ?l)G 35a 3f(D swo RD 407 PR# 2900 C-57 ✓ WC ✓ WAIVER A7 W C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ✓ E14CROACHMENTT DOCERMlr APP EHD 29-01 5109/12