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SAK JOAQUIN Environmental Health Department —COUNTY— S=Ic ,o„y<•Y Greatness 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 k 6 g -033S 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 South Windsor Ave.-City right-of-way, north of E Main St. CltylState2ip Siocklon/CA/95205 Phone NIA Cross Street East Main Street APN N/A Property Owner' City of Stockton Phone 209-937-8366 Address 345 N. El Dorado City/StateRlp Stockton/CA/95202 C-57 Contractor Cascade Drilling License# 1058336 Phone 916-638-1169 Address 3000 Duluth Street City/State2lp West Sacramento/CA/95691 Consultant/Sub-Contractor RDM Environmental,Inc:Mike Berrington License# CA PG 7124 Phone 916-749-9222 Address 8915 Los Poses Court City/State/Zip Granite Bay/CA/95746 CONSTRUCTION WORK TO BE PERFORMED: 'Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS W MONITORING 2 IN HOLLOWSTEM BORING DEPTH 65 it ®BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporWater) ❑ HAMMERIDRIVEN DIA.OF BOREHOLE 8-in ❑MULTIPLECASINGS❑MULTI-LEVELWELL CASING DIA ❑ SOILVAPORPROBE ❑ MUD ROTARY CASINGTHICKNESS Sch40 TYPE OF CASING: ❑STEEL ®PVC ❑ OTHER ❑ SOILBORING ❑ PUSH POINT(GP/CPT) CONDUCTORCASING ❑Yes ®No Boring Dla: Bin Casing Die: 2-in Casing Depth: 6511 ❑ INJECTION(AYSperm Ozanel ❑ HAND AUGER GROUTSEALDEPTH 42B TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ®PIPE ❑ OTHER ❑ .QTHER GROUT SEAL PUMPED? ®Yes ❑No (Nola:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs MW- 'A10and MW-11 (5p-p Abe) GROUT SPECIFICATIONS Neatoement.mixed 5 gal water per94 tosa&ofcemenl a per County requirement DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of—inches to depth of feet WELL IDs ❑PRESSURE GROUT To depth of feel below surface GROUT SPECIFICATIONS [I EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below sudace or feet below surface if>3 feet COMMENTS: Wells to be installed in City Stockton right-of-way and ROM will obtain City encroachment permit prior to installing wells. These wells are for CVRWQCB LUST case located at 3138 E Main St., Stockton (former E&R Freeman site) I hereby certify that I am authorized to complete this application and that the work will be done in accordance with -_ San Joaqu ou t Ordi lance Codes and Standards, and all other applicable California laws. Signed N p Title/Company Chief Geological Officer/RDM Environmental, Inc. Print Name Michael A. Barrington Date 10-11-2019 PARTMENT USE ONLY /� Q Application Accepted ey: Date Is ued: 1 - Zo 1 Grout Inspection Bey Dates: I 0 Destruction Inspection BylDates: Facilit /Site Information / /'- FA Name Hq 0 TIO ( �.F Address 3 �g £. t ( h FA# I OD ZI CoQ PR# 0,5�(7.7 D FA PE Z I WP Reviewed By 1 Work Plan Date I ❑C-57 G57Authoriza9onforOtherto Sign Pemdl []Workers Comp ❑Workers Comp Waiver ❑Emoaohmenl Permit ❑Ac Agreemenl ❑Lead Agenor Approval ❑MFR COMMENTS/C NDITIONS: C I01;4,/��(, l/ 4 ;A �— al "S rnq ��,�,f,�(h LW IA(� S• �y Noe. 1�re yII nd M� "1 °l7 M;5 �MIJ� A s or' la�r ka �Z ns;de vcl WP TYPE I PE SC FEE INFO AMT REMITTED CHECK# I RECV'D BY DATE WELL PERMIT# IN OICE# Permit 2g01 1 $152x O C.C. to 1 WPoo 1868 E. Hazelton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com EH029-01 09-01-17 5n CC)8tA10 �11 Permit Applicetbn 1^