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FILE COPY <br /> San Joaquin q County <br /> 4 -Environmental Health Department SITE �.. <br /> 600 E.Main Street, Stockton,CA 95202-3029 <br /> C " • " (209)468-3449 Fax;(209)468-3433 Web: www.sjgov.org/ehd MITIGATION <br /> �• �+� UNIT IV <br /> Well Permit Application r <br /> 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 is made incompliance with San <br /> Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> WELL Location 11396 N.Highway 99 Morse Assessors <br /> Cross Street Cpty.Lodi Zip 95240 Parcel# 05926010 <br /> PROPERTY <br /> Owner-T&T Trucking. Address 11396 N.Highway 99City Lodi Zip.95240 .Phon `209 931-6000 . <br /> C-57 Contractor Spectrum Exploration,Inc: Address 2365 Wigwam Drive City Stockton Zip.-L5205 Lie#512268 phone# 209-465-8712 <br /> Consultant/Sub Cntr. Brown and Caldwell 10540 White Rock Rd;Ste180 Rancho Cordova <br /> !` Address City Lit# Phone#916-444-0123 <br /> GIS Coordinates:X 6343306.26' Y 2212648.74. Township Range Section <br /> WORK TO BE PERFORMED: <br /> p NEW WELL 1 BORING (CPT,GEOPROBE,HYDROPUNCH,HAND-A <br /> SOIL BORING# UGER,OTHER*) DESTRUCTION (choose type below) <br /> Q <br /> 0 WELL#nsw-1,ASW-2,nsw-a,ASWA.nsw-s .0 OVER-BORE, DIAMETER <br /> ,yEw-s a PRESSURE GROUT <br /> *Other "' GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE . CONSTRUCTION SPECIFICATIONS <br /> V MONITORING a HOLLOW STEM DIA.OF BOREHOLE 6 to 8 .6 MULTIPLE CASINGS MULTI-LEVEL WELL CASING DIA: 1 and 3 <br /> n EXTRACTION PAIR HAMMER/DRIVEN CASING THICKNESS Schedule 40 TYPE OF CASING: U STEEL 0.PVC p OTHER: ' <br /> 0 VAPOR ©MUD ROTARY DEPTH OF GROUT SEAL 46'and 92' 'TREMIE TYPE TO BE-USED: <br /> 0 AUGERS Q HOSE <br /> 0 AIR SPARGEI OZONE 0 PUSH POINT(GP or CPT)GROUT SEAL PUMPED:.'B Yes _0'N0' .(NOTE: MAXIMUM FREE-FALL DEPTH IS 301 <br /> 0 SOIL BORING a HAND AUGER GROUT SPECIFICATIONS Neat-cement <br /> 0 OTHER: n OTHER APPROXI BORING DEPTH.60'and 110' B.BOLTED TRAFFIC.;OX or p STOVE PIPE' <br /> CONDUCTOR CASING PROPOSED No (if YES,list specifications in comment section) <br /> COMMENTS: h: <br /> NOTE: OFFSITE BORINGS:REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> r.. 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> `I hereby certify h I have relication and that the'work will be done in accordance-.with San Joaquin <br /> County Ordi all applicable California State Laws. <br /> Signed x TitlelCompany iN <br /> Print NameDat ~ <br /> DEPARTMENT USE ONLY NO)OLI <br /> SITE MAP IN UNIT IV FILE, ADDRESS: 11.39(o . A) U) <br /> WORK PLAN DATED: — 2-00 5 - <br /> ,Application Accepted By Date Issued� _ r Area w <br /> Grout Inspection By Date Final Inspection By <br /> Destruction Inspection By, Date <br /> COMMENTS I CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK# C' <br /> RED BY DATE PERMIT/SERVICE REQUEST# •, INVOICE <br /> uv 4V 3 X29 -/3 SR# �► <br /> C-57 WC=WAIVER_; C-57 Letter of Authorization to sign permitse"_Encroachment doc.lfi <br /> EHD 29-02-001 web <br /> 6122104 . <br /> .l <br />