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!N;.c San Joaquin County <br />Environmental Health Department <br />AS <br />600 East Main Street, Stockton, CA 95202-3029 <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />ORIGINAL 3/V <br />SITE <br />MITIGATION <br />UNIT IV <br />o)2�, 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 con ante with San <br />Joaquin?,lopment Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />�`CENTER STREET Assessors <br />ALLEY NORTH OF HARDING <br />WELL Location Cross StreetSTOCKTON Zip 95204 parcel# <br />PROPERTY Stockton 95204 <br />Owner City Of Stockton Address City Zip Phone# <br />C-57 Contractor BOART LONGYEAR <br />510 5TH STREET City COLUSA Zip 95932 Lic# 694686 Phone# 562-906-1960 <br />Consultant/ Sub CntrSECOR INTER. INC . Address 3017 KILGORE RD City RANRCDHO Lic# NA Phone# 916-861-0400 <br />GIs Coordinates: X -121.29465, 649796y 37.96770, 4203603 Township 1 NORTH Range 6 EAST Section 3 <br />WORK TO BE PERFORMED: <br />NEW WELL I BORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER') 0 DESTRUCTION (choose type below) <br />0 SOIL BORING # 0 OVER -BORE. DIAMETER <br />R WELL # DMW-9 0 PRESSURE GROUT <br />0 `Other GROUT SPECIFICATIONS <br />nnnnnnGnrrc• DMW-9 will be advanced using a sonic drilling rig Encroachment Permit # 71690, Revocable #07-26W <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 )� PVC 0 OTHER: <br />0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: p AUGERS 0 HOSE <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 />0 OTHER: _ROTHER SONIC APPROX. BORING DEPTH 75 FEET 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 />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 />Signed x p '""' -'"`-- Title/Company <br />SECOR INTERNATIONAL INCORPORATED <br />Print Name MICHAEL SPERBER <br />SITE MAP IN UNIT IV FILE, ADDRESS:_ <br />WORK PLAN DATED: <br />Application Accepted By <br />Grout Inspection By <br />Destruction Inspection By <br />COMMENTS / CONDITIONS: <br />Date i - 3 L C} <br />DEPARTMENT USE ONLY <br />5- <br />G <br />Date Issued <br />e Final Inspection By IIat <br />Date <br />ACCOUNTING ONLY: AID# FAC# <br />PE CODES <br />FEE INFO <br />AMOUNT REMITTED <br />CHECK # <br />REC'D BY DATE PERMIT / SERVICE REQUE # <br />INVOICE <br />L. - <br />C -57I/ WC ✓ -WAIVER_ C-57 Letter of Authorization to sign permit°' Encronc men oc_�/& ?0 <br />EHD 29-02-001 WEB �p/ ' ' / <br />9/11/2007 O �- 2 (O W <br />