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•"-QUI`, (` SAN.�'JOAQUIN Environmental Health Department {J COUNTY Greotness grows here. SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings Used for Contaminant Investigations and Remediation NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 48 Hours Advance Notice Required For All Inspections 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 Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. Job Address Sharpe Army Depot, 700 Roth Road City/State/Zip Lathrop, CA 95330 Phone N/A Cross Street N/A APN 198-020-01 Property Owner* U.S. Department of the Army Phone 831-242-4132 Address U.S.Army Garrison Presidio of Monterey Directorate of Public Works,P.O.Box 5004 City/State/Zip Monterey, CA 93944 C-57 Contractor Gregg Drilling &Testing License# 485165 Phone 925-313-5800 Address 950 Howe Road City/State/Zip Martinez, CA 94553 Consultant/Sub-Contractor Ahtna Environmental, Inc. License# N/A Phone 916-396-5309 Address 2255 Contra Costa Blvd, Ste 312 City/State/Zip Pleasant Hill, CA 94523 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOILVAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Airsoarae,ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL]SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS E D€STR ®OVER-BORE DIAMETER of 6 to 15 inches to depth of 18 to 55 feet WEL s EWNA1 EWNA3 MW494A MW496A ❑PRESSURE GROUT To depth of 0 feet below surface GR nt bentonite grout ❑EXPLOSIVES From to feet below surface T MIE TYPE TO BE USED ❑AUGERS ❑HOSE ®PIPE ®MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS:EWNA1 - 15"diameter over-bore to 45 ft bgs; EWNA3- 15"diameter over-bore to 55 ft bgs; MW494A-6"diameter over-bore to 18.5 ft bgs; MW496A-6" diameter over-bore to 18 ft bgs I hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed .�' < ;- Title/Company Sr. Geologist, Program Manager/Ahtna Environmental, Inc. Print Name Rachel Kerr, PG r� Date.lune 25, 2018 �o{i v tl w VY} DEPARTMEN USE ONLY pplication Accepted By: Date Issued: L7 / Grout Inspection By/Dates: 1 Destruction Inspection By/Dates: f4.," [ iilj (�6J4,'1(2 ,dbTis Facili /Site Information FA Name S 1 1} FA Address �'j� � � �,�� FA# ()0&1 PR# p FA PE io WP Reviewed By \/ Work Plan D:&ad -3 ElC-571�57 Authorization for 0ther'to(Sign Permit orkers Comp ❑Workers Comp Waiver`❑Encroachment Permit ❑Access Agreement Agency`ApprovalFR COMMENTS/CONDITIONS: WcAt a- A2'd�'se� e rmlt- w WP TYPE PE SC I FEE INFOA,M),T REMITTED CHECK# RECV'D BY DATE WELL PEpRMIT# INVOICE# Permit �1uZ 313 $152x 1 J�G�"� 37yy L )( �lzl �j 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 08-01-17 Site Mifigation Well Permit Application