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e � <br /> FILE COPY <br /> SAN JOAQUIN COUNTY <br /> y, ENVIRONMENTAL HEALTH DEPARTMENT Lop <br /> • 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION <br /> Telephone: (209) 468-3147 Fax: (209) 468-3433 Web:www.sigov.orp/ehd UNIT IV <br /> FO a <br /> WELL & BORING PERMIT APPLICATION <br /> FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION <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 in compliance with San <br /> Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health Department. <br /> Site Location 6700 Copperopolis Rd. Cross Street Alpine Road <br /> Property City/State Stockton Zip 95215 APN 10104022 <br /> Owner Richard Bozzano&FE Address 3000 N Arata Cit /State Stockton Zi 95205 <br /> Y p Phone 209-986-9091 <br /> C-57 Contractor Cascade Drilling,L.P. Address 3632 Omec CircleRancho <br /> City/State Cordova Lic 938110 Phone 916-638-1169 <br /> Consultant/Sub Cntr Address City/State Lic Phone <br /> Billable Party Address City/State Zip Phone <br /> GIS Coordinates:X Y <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 /> PE&#OF WELLJBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> -EWMONITORING VHOLLOW STEM DIA.OF BOREHOLE 8.25" Cl MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: 2 <br /> _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS Sch 40 TYPE OF CASING: ❑STEEL ❑PVC V OTHER Plastic <br /> _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL 39' TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE WPIPE <br /> _❑SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) <br /> _❑INJECTION(I.e.AlrSparge.ozone)❑HAND AUGER GROUT SPECIFICATIONS Neat Cement <br /> _❑OTHER: ❑OTHER: APPROX.BORING DEPTH 61' WBOLTED TRAFFIC BOX OR ❑STOVE PIPE <br /> COMMENTS: CONDUCTOR CASINGeNo[IYes:Casing Dia: Casing Depth: Boring Dia: <br /> NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) <br /> #OF WELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT <br /> WELL IDs: ❑ PRESSURE GROUT To DEPTH of FT BELOW SURFACE <br /> GROUT SPECIFICATIONS ❑EXPLOSIVES FROM To FT BELOW SURFACE <br /> TREMIE TYPE TO BE USED:❑AUGERS ❑ HOSE ❑ PIPE ❑MUSHROOM CAP AT L? <br />