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ORIGINA' <br />San Joaquin County <br />SOP.. •co <br />Environmental Health Department SITE <br />9:600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd UNIT IV <br />C. P <br />Well Permit Application <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <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 compliance with San <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department, <br />16 EAST HARDING WAY <br />Assessors <br />WELL Location Cross StreetCENTER STREETCity STOCKTON Zip 95204 Parcel# <br />PROPERTY 4108 BALLARD DRIVE MODESTO 95356 <br />Owner PAUL GOSAL Address City_ Zip 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 RANCHO Lic# NA Phone# 916-861-0400 <br />C=OVA <br />GIS Coordinates: X -121.29465, 649796Y 37.96770, 4203603 Township 1 NORTH __ Range 6 EAST Section 3 <br />WORK TO BE PERFORMED: <br />gl NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER*) 0 DESTRUCTION (choose type below) <br />0 SOIL BORIINGtN# 0 OVER -BORE, DIAMETER <br />Ij WELL # 0 PRESSURE GROUT <br />0 *Other GROUT SPECIFICATIONS <br />COMMENTS: DMW-4 AND DMW-5 will be advanced using a sonic drilling rig equipped <br />with inc ame er eavy-wa e own- o e casing o a o a ep o ee qs. <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 )I PVC 0 OTHER. <br />0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE <br />0 AIR SPARGE/ OZONE 0 PUSH POINT (GP or CPT)GROUT SEAL PUMPED: 5tYes 0 No (NOTE: MAXIMUM FREE -FALL DEPTH IS 30') <br />0 SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br />0 OTHER: 5tOTHER 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. J <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <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 />County Ordinances, Rules and Regulations, and all applicable California State Laws. <br />SECOR INTERNATIONAL INCORPORATED <br />Signed x Title/Company <br />MICHAEL SPERBER I <br />MCDate <br />Print Name <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS: p <br />WORK PLAN DATED: LB4 <br />Application Accepted By Date Issued .-_ / _Area v <br />Grout Inspection By Date Final Inspection 13y_ e° -P - to 3-A-61 <br />Destruction Inspection By Date <br />COMMENTS / CONDITIONS: <br />ACCOUNTING ONLY: AID# FAC# ---------- <br />PE CODES <br />FEE INFO <br />AMOUNT REMITTED <br />HE # <br />REC'D BY <br />DATE PERMIT/ REQUEST <br />INVOICE <br />SR*C)0 <br />C-57 V/ WC V/1 -WAIVER_ C-57 Letter of Authorization to sign ermiW Encroachment doc�t4/4 <br />F.FID 29-02-001 WEB / C <br />9/11/2007 <br />