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i lili�fi1V84 SITE MITIGATION WELL & BORING PERMIT APPLICAT N For Wells'and Borings Used for Contaminant Investigations and Remed tior3UL 10 2019 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ENVUTUNMENIAL HEALTH ti? ,'i4`; . . ,s <tr*.ia` aa7ioz xS:'?ls:C r;:.. ,'t:.�;fJ rC3 Ai' Ii'tr.`oo- ns DEPARTMENT 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 Y Ywa Alle s,North of Main Street Cityistale/Zip Ripon CA 953M Phone Cross Street N/A APN Property Owner* City of Ripon Phone (209599-2108 Address - 259 N Wilma Avenue City/statelzip Ripon,CA 96366 916-368-t 169 C-57 Contractor Cascade Drilling Technical Services License# 938110 Phone Address 3000 Duluth Street CItylState/Zip West Sacramento, CA 95691 Phone ECMConsullanlslHale SAiddch 661-255-2798 ConsultaMlSub-Cordractor y License# Address 3525 Hyland Avenue City/StatelZip Costa Mesa CA 92626 CONSTRUCTION WORK TO BE PERFORMED:'Nme: ONsite Bedngs/VVells Require Access Agreements or Encroachment Permits PE F VELLSORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS MONITOPoNG p HOLLOW STEM BORINGDEPTH 25.5feelbgs ❑BOLTED TRAFFIC60% ❑STOVEPIPE EXTRACTION(VeporNJater) ❑ HAMMERIOr7NEN DIA.OF BOREHOLE - 2inth ❑MULTIPLE CASINGS❑MIRTTUTVELWELL CASING UTA bk SOILVAPOR PROBE �s'I MUDROTARY CASING THICKNESS--TYPE OF CASING, []$%a- ❑PVC ❑ OTHER ❑ SOIL BORING L"1 PUSH POINT(GPICPI) CONDUCTOR CASING ❑Yes ❑No Bming Dix Caseg Pa Cesng Depth' ❑ INJECTION fAiaovoa Oexal ❑ HANDAUGER GROUT SEAL DEPTH TRENIETYPETO BE USER. DAUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:MadmumFeedall Depth is30Fq WEW SOILBORNGIDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLYI #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of_feel WELL IDs ❑PRESSUREGROUT To depth of_feelhebw surface GROUT SPECIFICATIONS ❑EXPLOSIVES Fmm_to_feet balm surface TREMIE TYPE TO BE USED ❑AUGERS []HOSE []PIPE ❑MUSHROOM CAP ❑3 feetbdowsurfaee or feet below surface K>3 feet COMMENTS: I hereby certify the11 am authorized to completoth{a application and that tee work will be done in accordance with San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed �� "Va, Title/Company Program Manager, ECM Consultants Print Name (nayak A arya Date July 3,2019 _ DEPARTMENT USE ONLY Application Accepted By. Dates Issued: -7 Grout inspection By/Dates Destruction inspection By/Dates: Facliil ISlte Informal on FAName FAAddress .v3o FA# -�� Pi 0S 607 Reviewed By Work Plan Dale GS7 ❑C57AalhNbgMfMOthObD,'ga PamM akersCemp ❑wallets Compwatm ardPamtit ❑AcceesAgreement Lead Anpnq Apprwd MFR COM ENTSICONDITIONS: �r/'n M WP TYPE PE SC FEE INFO AMT 13 REMI E. RI X N' BY/ DATE nW,nE�LLL PEERMIT# INVOICE# _ Permit $152x a /''? j/ Pau 3 1868 E. Hazeiton Avenue I Stockton: California 952051 T 209 468-3420 1 F 209 464-0138 1anwal Pam!Appltrd.c rr EHD 2"i OMi-17 Sim