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Bank of America, N.A. 354922 <br /> I ro'aamaia�d 70-2328/719 IL CHECK DATE <br /> b Ittass n <br /> 630 Plaza Drive,Suite 600•Highlands Ranch,Colorado 80129 <br /> Te1720/344-3500•Fax 72o/3aa-3535 September 6, 2023 <br /> PAY AMOUNT <br /> One thousand two hundred sixteen and 00/100 <br /> 1,216.00 <br /> TO San Joaquin County Environmental ARCADIS <br /> Health Department <br /> 1868 E Hazelton Aven1eF.l��cuw. <br /> Stockton,CA 95205 �. <br /> United States [ VOID ARTIER 90 DAYS <br /> au b� ev"re` 11. 3S4922110 1:07i9232a411: 876SO304420 <br /> RECEIVED <br /> Environmental Health Depart nt <br /> SEP 0 7 2023 "qk'�'j <br /> ENVIROrryy�� rgg��. WEALTH ��0461,"�YJ' <br /> PERIL WA ATION WELL & BORING PERMIT APPLICATIOK/A 0"� <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED y, 1�JC_'7 '0 <br /> 24 Hours Advance Notice Required For All Inspections c,<r Ro ui 23 <br /> CALL (209) 953-7697 For INSPECTIONS y�FpMF00 T <br /> Application is hereby made to San Joaquin County fora permit to construct and/or install the work described. ART/✓IF�N y <br /> This application is made in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. <br /> Job Address 401 North San Jose Street - City/State/Zip Stockton CA 95203 Phone <br /> Cross street North San Jose Street and West Lindsay Street APN 13526016 <br /> Property Owner" Chevron Environmental Management Company Phone 952-842-1000 <br /> Address 6101 Bollinger Canyon Road City/State/Zip San Ramon, CA 94583 <br /> C-67 contactor Cascade Drilling License# Phone <br /> Address 3459 Collins Avenue citylstate/zip Richmond CA 94806 <br /> Consultant/Sub-Contactor Areadis License# Phone 925-274-1100 <br /> Address 101 Creekside Ridge Ct City/State/Zip Roseville, CA 95678 <br /> CONSTRUCTION WORK TO BE PERFORMED: `Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits <br /> TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 25 feet ®BOLTED TRAFFIC BOX ❑STOVE PIPE <br /> ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DA.OF BOREHOLE 2lnches ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING CIA <br /> ® SOILVAPORPROBE 11 ❑ MUD ROTARY CASING THICKNESS N/A TYPE OF CASING: El STEEL El PVC ❑ OTHER <br /> ® SOIL BORING 11 ® PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No Boring Dian Casing Dia: Casing Depth: <br /> ❑ INJECTION IAw Stage ozone) ® HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: El AUGERS [I HOSE [I PIPE <br /> ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefel Depth is 30 Ft) <br /> WELL/SOIL BORING IDS SV-10,SV-11,SV-12,SV-13,SV-14,SW15, GROUT SPECIFICATIONS <br /> SV16SV17,SV1SSV19SV20 <br />