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r Pa"'"• SAN JOAQUIN COUNTY �0.��•cGG ENVIRONMENTAL HEALTH DEPARTMENT LOP �• 1868 East Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION �`�'• - P Telephone: (209) 468-3454 Fax: (209) 468-3433 Web:www.sogov.org/ehd UNIT IV A�IFOR�` 7 �. _ WELL & BORING PERMIT APPLICATION itU V d d I �� FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 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 Joaquin County Development Title, Chapter 9-1115.3, and the Standards of the San Joaquin County Environmental Health Department. Site Location 1010 Zephyr St. Cross Street So.Airport Way Cit, Stockton Zip 95206 APN 17-28-13 Property tl I Inc. nIn redion co Corn Products/1021 Stockton Owner CPC � g � Address / CPdt /1021 Idtity StktZip 95206 Phone 209 547-8233 C-57 Contractor Enprobe Address P.O. Box 6093 City Oroville 95966 Lic 777007 Phone 530 589-2019 Consultant/Sub Cntr Kleinfelder Address 2001 Arch-Airport Rt., Ste. 100 City Stockton 95206 Lic Phone 209 948-1345 Billable Party APCI/Scott Govert Address 555 First St., Suite 302 City Benicia Zip 94510 Phone 707-748-7595 GIS Coordinates:X 37.911287 Y -121.263697 CONSTRUCTION WORK TO BE PERFORMED: NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) LX] SOIL BORING IDs PP1 through PP 33 ®WELL IDs MW-1 MW-2 ❑OTHER IDS TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS r�I MONITORING x2 6 HOLLOW STEM DIA.OF BOREHOLE 2"/8" ❑MULTIPLE CASINGS❑ MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS 2 TYPE OF CASING: ❑STEEL 8 PVC ❑ OTHER _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE _❑SOIL BORING 2�PUSH POINT(GP/CPT)X33 GROUT SEAL PUMPED:(3 Yes ❑ No(MAXIMUM FREE FALL DEPTH IS 3 FT / _❑ INJECTION(ie Ar Sparge.Ozone)El HAND AUGER GROUT SPECIFICATIONS yd,0�Pn��hl�C 3.��/1 �ft�Cf7NNA�w�,/�A1�oyl SIG NG�71`e�1� ❑OTHER: ❑OTHER: APPROX.BORING DEPTH 10-45' Ell BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING®No❑Yes:Casing Dia: 2 Casing Depth: 45' Boring Dia: 8 COMMENTS: 2 MWs to 45' 33 push probe to --10'depth NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED:Push probes only DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #OF WELL(S)TO BE DESTROYED ❑ OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT WELL IDs: PP1-PP33 de th — 10') ® PRESSURE GROUT TO DEPTH OF _ 10' FT BELOW SURFACE ROUT SPECIFICATIONS rout Ne4f cl►�n 119/1115 W NO El EXPLOSIVES FROM TO FT BELOW SURFACE REMIE TYPE TO BE USED: AUGERS ❑ HOSE 4 PIPE El MUSHROOM CAP AT L3 FT) FT BELOW SURFACE COMMENTS FelnOl KS o,3 S W v h l f i i 5 WOR G DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify I have a ared1,nIa s application and that the work will be done In accordance with San Joaquin County Ordinances,Rules and Regulations, 'all ap i Ca Laws. Signed Title/Company Senior Geolo ist/Kleinfelder Print Nam Do g Heard, P. Date I �- DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE SITE ADDRESS IP40 Hy 4 �1 &/-,7 WORK PLAN DATED ��l �G/ �AI Z APPLICATION ACCEPTED BY &✓I fire &�ett, DATE ISSUED �7Z� AREA GROUT INSPECTION BY FINAL INSPECTION BY DATE DESTRUCTION INSPECTION BY DATE /- 1 COMMENTS/CONDITIONS: Wt-I15 6r2,- h 11, J 0 i/Ni� / 1115 W`Vrl 57�/ ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO# INVOICE G REQUEST PR# 125 x Z SR# Z� RO I/ 00 17 97 j � PR# 2900 C-57 WC X WAIVER M C57 LETTER OF AUTHORIZATION TO SIGN PERMIT X ENCROACHMENT DOC