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San Joaquin County <br />_. Environmental Health Department <br />600 East Main Street, Stockton, CA 95202-3029 <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br />Well Permit A plication W11• 10 <br />ORIGINAL"' <br />SITE <br />MITIGATION <br />UNIT IV <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED �Z <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 c�riliance with San <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />/7EL DORADO Assessorsos �w <br />WELL Location 'oss StreeCity STOCKTON Zip 95204 Parcel#1 <br />PROPERTY ; Stockton 95204 1 � / 9 <br />Owner City Of Stockton 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 <br />3017 KILGORE RD CityRANCHO Lic# NA Phone# 916-861-0400 <br />GIS Coordinates: X -21.29465, 649796Y 37.96770, 4203603 Township 1 NORTH Range 6 EAST Section <br />WORK TO BE PERFORMED: <br />NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER`) 0 DESTRUCTION (choose type below) <br />0 SOIL BORING 0 OVER -BORE. DIAMETER <br />R WELL # 0 PRESSURE GROUT <br />0 "Other GROUT SPECIFICATIONS <br />COMMENTS: DMW-10 will be advanced using a sonic drilling rig Encroachment Permit # 71689, Revocable #07-27W <br />TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />fit] 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 J5 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: Ryes 0 No (NOTE: MAXIMUM FREE -FALL DEPTH IS 30') <br />0 SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br />0 OTHER:_R OTHER 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 />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 �s``�= ' Title/Company <br />Print Name MICHAEL SPERBER Date <br />DEPARTME_1N'T USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS: CPJI� D <br />WORK PLAN DATED: <br />Application Accepted By <br />Grout Inspection By_ <br />Destruction Inspection 8 <br />COMMENTS I CONDITIONS: <br />Date <br />nal Inspection By <br />WAM <br />-0 <br />ACCOUNTING ONLY: AID# FAC# <br />PE CODES <br />FEE INFO <br />AMOUNT REMITTED <br />CHECK # <br />REC'D BY <br />DATE PERMIT /SERVICE REQU T # <br />INVOICE <br />sR#5 3 0 3 <br />C-57_ WC ✓ -WAIVER_ C-57 Letter of Authorization to sign permit_ ncroac ment doc-9 <br />rltD29-02-001 WEB /J_,, ' <br />9/11/2007 ��-w -' v77 <br />