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SAN JOAOUIN Environmental Health Department <br />(916) 865-3135 <br />Phone (925) 674-8400 <br />Phone (925) 313-5800 <br />Phone <br />WELU SOIL BORING IDs <br />TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE 0 PIPE <br />(Note: Maximum Freefall Depth is 30 Ft) <br />Boring Die: Casing Die: Casing Depth: <br />TYPE OF WELL/BORING <br />ID MONITORING <br />EXTRACTION (Vapor/Water) <br />SOIL VAPOR PROBE <br />SOIL BORING <br />INJECTION lAle Spaoe,Ozoriel <br />OTHER <br />NUMBER INSTALLATION TYPE <br /> ID HOLLOW STEM <br /> o HAMMER/DR1VEN <br /> CI MUD ROTARY <br /> 0 PUSH POINT (GP/ CPT) <br /> o HANDAUGER <br />0 OTHER <br />CONSTRUCTION SPECIFICATIONS <br />BORING DEPTH <br />DIA OF BOREHOLE <br />CASING THICKNESS <br />CONDUCTOR CASING 0 Yes D No <br />GROUT SEAL DEPTH <br />GROUT SEAL PUMPED? 0 Yes 0 No <br />GROUT SPECIFICATIONS <br />0 BOLTED TRAFFIC BOX 0 STOVE PIPE <br />0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA <br />TYPE OF CASING: 0 STEEL 0 PVC 0 OTHER <br />DESTRUCTION WORK TO BE PERFORMED: <br /># WELLS TO BE DESTROYED Six <br />WELL IDs EW-04, EW-04A,INJ-14, PW08-076, PW08-155, PW08-180 <br />GROUT SPECIFICATIONS Neat cement grout <br />TREMIE TYPE TO BE USED p AUGERS 0 HOSE tgj PIPE <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY( <br />o OVER-BORE DIAMETER of__ inches to depth of feet <br />0 PRESSURE GROUT To depth of 218 feet below surface <br />[S] EXPLOSIVES From to feet below surface <br />vo MUSHROOM CAP tx 3 feet below surface or feet below surface if >3 feet <br />s Date Issued: Application Accepted By: <br />—COUNTY <br />Grecrtne, 91 L,r.v. here. <br />SITE MITIGATION 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 />48 Hours Advance Notice Required For All Inspections <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. <br />This application is made in compliance with San Joaquin County Development Tide, Chapter 9-1115,3, and the San Joaquin County Well Standards. <br />Job Address Murphy Parkway <br />Cross Street D'Arcy Parkway <br />RECEM <br />JAN 05 2018 <br />EN VIRONMEN T HEALD. <br />Property Owner*R&B Louise LLC et al (attn: Dana Parry) <br />Address do Reynolds and Brown, 1200 Concord Ave, Suite 200 City/State/Zip Concord, Ca 94520 <br />C-57 Contractor Gregg Drilling and 'resting License# 485165 <br />Address 950 Howe Road <br />Consultant/Sub-Contractor Arcadis U.S. Inc <br />Address 101 Creekside Ridge Court, Suite 200 <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits <br />COMMENTS: <br />Print Name Date I 1-'2'1 -1 1 <br />I hereby certify that I am authorized to complete this application and that the work will be done in accordance with <br />San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. <br />Title/Company Signed <br />DEPARTMENT USE ONLY <br />Grout Inspection By/Dates F r.,--o,4 /I z lit I. <br />Destruction Inspection By/Dates:\d A3.- Li I e. ottit f — ti-S" z //4114 <br />Facility/Site Information <br />FA Name <br />- 6 cc_ FA Address <br />, <br />, A -77 -7 1/43\ j c, ji FA # (Jo 2,47 2.....to PR# 0 Szi.--7 • <br />FA PE ,,, .t..,a, i 7J) WP Reviewed By Work Plan Date <br />0 C-57 0 C-57 Authorization for Other to Sign Permit 0 Worker's Com 0 Workers C Waiver 0 Encroachnlent Permit 0 Access A ment E1 Lead Agency Approval .10 MPR <br />COMMENTS/CONDITIONS: Ob hi.:. vs- car\rr %.,-- 1.-c).- Ddy -J-- e'r 3 1---" ---e-, , ‘,..ibi•-•=ii-cx, p-, <br />//A.A.— P'" C•411/41:4-)— 4 5(4'6 - 3 - 6, raf.-11- w1,4 474.....4- _ ..dA,ii...,..,---+- el._... . <br />WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# <br />Permit H S152 x <br />1868 E. E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 ( www.sjcehd.com <br />EHD 29-01 08-01-17 te Mitigation Well Permit Application <br />An) " ° .s4z- oo 7'10 .z,7 <br />C Ze_7) APN 198-179-38 f i v/ —C:14 / <br />City/State/Zip Lathrop, Ca Phone <br />City/State/Zip Martinez, California 94553 <br />License# <br />City/State/Zip Roseville, Ca 95678