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114 <br />San Joaquin County <br />Environmental Health Department <br />wIt b 600 East Main Street, Stockton, CA 95202-3029 <br />(209) 468-3449 Pax: (209) 468-3433 Web: www.sjgov.org/ehd <br />1 <br />ORIGINAI <br />SITE <br />MITIGATION <br />UNIT IV <br />Well Permit Application r <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED / I- ` o <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in com lance with San <br />Joaquin C u ty Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />E. HARDING WAY Ent} Pl ff96ftf�B� JQ�_ Assessors R O w <br />WELL Lo a ion ross Street City STOCKTON Zip 95204 parcel# <br />PROPERTY �2 /� � 0 0e,Y� Stockton p 95204 <br />Owner Cit Of Stockton Address rll � ""C�iTyry Zi Phone# <br />C-57 Contractor BOART LONGYEAR_Address 510 5TH STREET City COLUSA Zip 95932 Lic# 694686 Phone# 562-906-1960 <br />Consultant / Sub CntrSECOR INTER. INC . Address 3017 KILGORE RD City RANNC O Lic# NA Phone# 916-861-0400 <br />FEE INFO AMOUNT REMITTED <br />3770, <br />REC'D BY <br />GIS Coordinates: X -121.29465, 649796y 4203603 Township 1 NORTH Range 6 EAST Section 3 <br />INVOICE <br />WORK TO BE PERFORMED: <br />350 ► <br />�] NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER-) O DESTRUCTION (choose type below) <br />22 <br />0 SOIL BORING # 0 OVER -BORE. DIAMETER <br />RWELL# DMW , an 0 PRESSURE GROUT <br />0 *Other GROUT SPECIFICATIONS <br />COMMENTS: DMW-6, DMW-7, DMW-8, will be advanced using a sonic drilling rig Encroachment Permit # 71688, Revocable #07-25W <br />TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />N MONITORING 0 HOLLOW STEM DIA. OF BOREHOLE 8.25 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: 2 -INCH <br />0 EXTRACTION 0 AIR HAMMER/DRIVEN CASING THICKNESS SCH. 40 TYPE OF CASING 0 STEEL )Q PVC 0 OTHER: <br />0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED. 0 AUGERS 0 HOSE <br />(� <br />0 AIR SPARGE/ OZONE 0 PUSH POINT (GP or CPT)GROUT SEAL PUMPED: RYes 0 No (NOTE: MAXIMUM FREE -FALL DEPTH IS 30') <br />0 SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br />O OTHER: IZOTHER SONIC APPROX. BORING DEPTH 75 FEET R BOLTED TRAFFIC BOX or 0 STOVE PIPE <br />CONDUCTOR CASING PROPOSED (if YES, list specifications in comment section) <br />COMMENTS: During advancement, soil samples will be collected continuously using a 20 -foot core barrel. <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />3 <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />�? <br />County Ordinances, Rules and Regulations, and all applicable California State Laws. <br />Signed x Title/Company SECOR INTERNATIONAL INCORPORATED <br />S <br />Print Name MICHAEL SPERBER Date `'� "" C) <br />DEPARTMENT USE ONLY <br />6` G C)� I rA•I <br />SITE MAP IN UNIT IV FILE, ADDRESS: ./& <br />WORK PLAN DATED: �d <br />Application Accepted ByDate Issued Area <br />Grout Inspection By Date Final InspectionB,y. _Date <br />Destruction Inspection By Date <br />COMMENTS I CONDITIONS: <br />a <br />ACCOUNTING ONLY: AID# FAC# <br />PE CODES <br />FEE INFO AMOUNT REMITTED <br />CHECK # <br />REC'D BY <br />DATE PERMIT REQU <br />INVOICE <br />350 ► <br />M1 <br />22 <br />.ems <br />C-57 ✓ WC✓ -WAIVER_ C-57 Letter of Authorization to sign hermit_ ncr &cc <br />9/9/11 /9-07-001 WEB /j •.A: q. ' 55 I <br />11/2007 �( Gd) W <br />