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SANAAQuIN Environmental Health Department ! / 0 COUNTY er/ Greatness grows here. SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings Used for Contaminant Investigations and Remediation NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 48 Hours Advance Notice Required For All Inspections 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 San Joaquin County Well Standards. Job Address 1810 E. Hazelton Avenue City/State/Zip Stockton, CA 95205 Phone (209) 468-3000 Cross Street S. B Street APN 155-18-002 Property Owner* San Joaquin County General Services Department Phone (209) 468-9598 Address 44 N. San Joaquin Street, Suite 590 City/State/Zip Stockton, CA 95202 C-57 Contractor V&W Drilling, Inc. License# C57-720904 Phone (209) 469-7700 Address 1133 Blackhurst Drive City/State/Zip Galt, CA 95632 Consultant/Sub-Contractor Condor Earth License# Phone (209) 234-0518 Address 188 Frank West Circle, Suite I City/State/Zip Stockton, CA 95206 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE El MONITORING 3 El HOLLOW STEM EXTRACTION (Vapor/Water) 0 HAMMER/DRIVEN SOIL VAPOR PROBE 0 MUD ROTARY SOIL BORING 0 PUSH POINT (GP/ CPT) INJECTION (Air &am. ()wet 1 ID HAND AUGER OTHER 0 OTHER: WELU SOIL BORING IDs MW-8, MW-'9, CONSTRUCTION SPECIFICATIONS BORING DEPTH 6.215-50' DIA. OF BOREHOLV4644Ch CASING THICKNESS CONDUCTOR CASING 0 Yes 0 No GROUT SEAL DEPTH E BOLTED TRAFFIC BOX 0 STOVE PIPE 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA TYPE OF CASING: 0 STEEL El PVC 0 OTHER Boring Dia: 8.25" Casing Dia: 2" Casing Depth: 45-50' TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE 1:83 PIPE GROUT SEAL PUMPED? 0 Yes 0 No (Note: Maximum Freefall Depth is 30 Ft) MW-10, OW-7 (map attached) GROUT SPECIFICATIONS Neat Cement over hydrated bentonite from surface to filterpack, approximately 2 feet above screen (see attached proposed construction details) DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) # WELLS TO BE DESTROYED El OVER-BORE DIAMETER of inches to depth of feet WELL IDs ID PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS 0 EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED U AUGERS CI HOSE El PIPE El MUSHROOM CAP El 3 feet below surface or feet below surface if >3 feet COMMENTS: Monitoring wells MW-8, MW-9, MW-10 proposed to 45-50 feet depth, 15 feet 0.010 screen, #2/12 sand to 2 feet above screen, neat cement over hydrated bentonite from filterpack to ground surface; Ozone injection well OW-7 with 18" sparge point to approximately 47 feet, 4 feet of sand pack, #3 sand, 2 foot bentonite seal, neat cement grout to surface Signed 4..<,............,_______- Title/Company PG #6795/Condor Earth ,.....30 San Joaquin 4 County Ordinance Codes and Standards, and all other applicable California laws. I hereby certify that I am authorized to complete this application and that the work will be done in accordance with Print NameJohn P. Lane Date %-la6 ((7 DEPARTMENT USE ONLY Application Accepted By: Grout Inspection By/Dates: Date Issued: ) I 7 Destruction Inspection By/Dates: Facility/Site Information FA Name j .i t, r19 0 i _ hA Address t6' " {... ti.42A .11-ve., FA# 00 z.:S 3,553 PR# FA PE )91 ki+0 WP Reviewed By 1.- -X Work Plan Date tta i u.ta a ii 0 C-57 lEtt--57 Authorization for Other to Sign Permit Etcorker's Comp 0 Worker's Comp Waiver 0 Encroachment Permit 0 Access Agreement Not‘d Agency Approval IRKFR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit asvo 1 5i.1 $152x 'LA ck,DC 63i L- .-)( "-I t il t -1 V VACb ' ii,A1,0 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com w END 2?-01 0(791- 1 7 3 It. ,A 11111.111 Application