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• r �P4UIN'•C SAN JOAQUIN COUNTY FIL E copy Q: ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: 209 468-3454 Fax: 209 ��..'...:.�` P ( ) 468- ,.!_o»✓ ( ) 3433 Web: www.si4ov.orQ/e�dEeffvl WELL & BORING PERMIT APPLICATION JUL 2 4 2012 FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ENVIRONMENTALHEALTHPERMIApplication is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in omTplianc�e v�n`tRan Joaquin County Development Title, Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health Department. 1010 Ze rr-Z1- O I Site Location phyr St. Cross Street So.Airport Way St3 Property City Stockton Zip 95206 APN 11 7-2 811 3 Owner CPC Inc. Intl(Ingredion) Addressc/o Corn Products/1021 Industri-- Stockton 95206 tY Zip Phone 209 547-8233 C-57 Contractor Enprobe Address P.O. Box 6093City 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 —Zi 94510 37.911287 -12-121.263697one Phone 707-748-7595 GIS Coordinates:X Y CONSTRUCTION WORK TO BE PERFORMED: ® NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) C SOIL BORING IDs PP1 through PP 33 ®WELL IDs MW-1 MW-2 ❑ OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS MONITORING x2 I6 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 IN PVC ❑ OTHER _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE _❑SOIL BORING [A PUSH POINT(GP/CPT)X33 GROUT SEAL PUMPED:®Yes ❑ No(MAXIMUM FREE FALL DEPTH IS 3 _❑ INJECTION(I a Alr Sparge.ozone)❑HAND AUGER GROUT SPECIFICATIONS X 70 a61� h%><C 3 S �4 �1////1/ <C'{Hth7 A/ 7 f ►($ _❑OTHER: ❑OTHER: APPROX.BORING DEPTH 10-45' IS BOLTED TRAFFIC BO OR ❑STOVE PIPE , � COMMENTS: 2 MWs to 45' 33 push probe to —10'depth CONDUCTOR CASING®No❑Yes:Casing Dia: 2" Casing Depth: 45, Boring Dia: 8 NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: Push probes only DESTRUCTION METHOD' (CHECKALL THAT APPLY) _#OF WELL(S)TO BE DESTROYED ❑ OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT WELL IDs: PP SPECIFICATIONS (depth — 10' ® PRESSURE GROUT To DEPTH OF — 10' FT BELOW SURFACE GROUT SPECIFICATIONS Grout — (U,+9 �p-u�5 GBHtgi ri�2 [I EXPLOSIVES FROM To TREMIE TYPE TO BE USED:❑AUGERS ❑ HOSE X IPE ,ny-' MUSHROOM CAP AT L3 F FT BELOW SURFACE 'COMMENTS nl��(� ru oar,{- Al,X,��/ GU/7 a�l/o1f5 #Nd a��o,,l LF 4 ,*T71/�S � FT BELOW SURFACE 5 WOR G DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify I have repared is application and that the work will be done in accordance with San Joaquin County Ordinances,Rules and Regulations, all ap i b/e Ca ' rnia Laws. Signed ` Title/Company Senior Geolo ist/Kleinfelder Print Nam Do g Heard, P.G EIIl Date DEPARTMENT USE ONLY ECEIVEED SITE MAP IN UNIT IV FILE SITE1-ADDRESS �4�0 Z11 y K ,lD ✓��Y�'c f 5 fyj�fa� II 7()17 2912 WORK PLAN DATED a �/Z, Imo— 2 APPLICATION ACCEPTED BY -P DATE IS UQUI UNTY GROUT INSPECTION BY FINAL INSPECTION BY J u ALTH D LlfII1J S�3-/Z DESTRUCTION INSPECTION BY DATE ,-OMMENTS/CONDITIONS: �S (�� / �� /� ! f'j!/ d/ s 1✓ A ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO# f ¢ 2 �O REQUEST PR* INVOICE 2 / $ 125 x Z �1 .�1�� 75P7 o Z7�/Z SR# Z�oS �Z5 RO# r 27a� 37� � ?17Jr PR# J D 2soo 57 WC _WAIVER C5��ER F AUTF{O�IZATION TO SIGN PER ENCROACHMENT DOC