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ILE Copy <br /> a !n SAN JOAQUIN COUNTY AGPiVE1.) <br /> —m ENVIRONMENTAL HEALTH DEPARTMENT LOP <br /> 1868 Hazelton Avenue, Stockton, CA 95205-62 N 0 2 2014 SITE MITIGATION <br /> UNIT IV <br /> Telephone:(209)46147 Fax_ w <br /> (209)468-3433 Web-ww.s' ov.or lehd <br /> 8-3 <br /> FOR' NTAL HEALTH <br /> WELL & BORING PERMIT APPLIC /SERVI��� <br /> FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REM TION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County for a pemlit 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 26933 Hansen Rd Cross Street w Schulte Rd City/State Tracy/CA zip 95377 APN 20911006 <br /> Properly Trac CA (209) 836-4600 <br /> Owner Musco Family Olive Co. Address 17950 Via Nicolo Rd City/Stats y/ Zip 95377 Phone <br /> CS7Contractor v&W Drilling, Tnc. Address 3806 Duck Creek or Clty/State Stockton/CA LlC 720904 Phone (209) 469-7700 <br /> Terraphase Etgineeri Sri 1404 Franklin St, Ste 600 City/State Oakland/CA L•IC 960398 Phone (510) 645-1850 <br /> Consultant/Sub Cnh' tl <br /> Billable Party`erraphese Engineering Tnc Address 14D4 Franklin St, Ste 600 City/State Oakland/CA ZIP94612 Phone (510) 645-1850 <br /> GIS Coordinates:X 6266637.191 ft Y 2082078.256 ft (State Plan Coordinate System, NAD83) <br /> .703$— <br /> CONSTRUCTION WORK TO BE PERFORMED: <br /> ❑X NEW WELU130FUNG(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) <br /> ❑SOIL BORING IDS <br /> ®WELL IDS MW-33, MW-34, MW-35 <br /> ❑OTHER IDs <br /> TYPE&#OF WELLJBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> _®MONITORING ®HOLLOW STEM DIA OF BOREHOLE 8 in 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: <br /> _0 EXTRACTION:Vapor/Water 0 HAMMER/DRIVEN CASING THICKNESS S R 40 TYPE OF CASING: ❑STEEL IM PVL 0 OTHER <br /> _0 SOIL VAPOR PROBE ®MUD ROTARY DEPTH OF GROUT SEAL-176 ft TREMIE TYPE TO BE USED: IMAUGERS 0 HOSE 0 PIPE <br /> _0 SOIL BORING ❑PUSH POINT(GP/CPI) GROUT SEAL PUMPED•My— ❑No(MAXIMUM FREE FALL DEPTH IS SOFT) <br /> _0INJECTION r e Aircmre Oaaml❑HAND AUGER GROUT SPECIFICATIONS Neat cement <br /> _0 OTHER: ❑OTHER: APPROX.BORING DEPTH 209 ft 0 BOLTED TRAFFIC BOX OR ❑STOVE PIPE <br /> CONDUCTOR CASING M No 0 Yes:Casing Dia: Casing Depth: Bonng Die:_ <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 /> #OF VVELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER OF INCHESTODEPHOF Fr <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:E]AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP AT L3 FT} Fr BELOW SURFACE <br /> COMMENTS <br /> 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE)FOR INSPECTION APPOINTMENTS <br /> I hereby certify that I have prepared this apps-cation and that work will be done in accordance with San Joaquin County Ordinances,Rules and <br /> Regulations,5pq aB app eCall' i s. <br /> Signed -Tite/Company Principal Geologist & Vice President/Terranhase <br /> Print Name Andrew Romolo Date 12/30/2013 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE-SITE ADDRESS O L/lig /I// cI L e) <br /> WORK PLAN DATEDU Cy7v <br /> APPLICATION ACCEPTED BY S• Ku DATE 1 <br /> GROUT INSPECTION BY FINAL INSPECTION BY <br /> DESTRUCTION INSPECTION BY DATE <br /> COMMENTSICONDITIONS <br /> ACCOUNTING ONLY: AID# FAC# <br /> SERVICE RO# INVOICE <br /> PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE REQUEST 1 PR# <br /> stzsX '-O Jr33 �vulurE I-2-ry slx# 485 / <br /> RO# <br /> 1 <br /> �,9e) V5- (35 0) <br /> PR# J <br /> X900 <br /> C-57 ✓ INC ✓ WAIVER A/r C-57 LETTER OFAUTHORRATION T05IGN PERMIT _Z _ENCROACHMENT DOG N,!�-- <br /> W <br /> EHD 29-01 5/09M2 WELL PERMIT APP <br />