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SAN JOA{JU|NCOUNTY <br />ENVIRONMENTAL ------------ <br />- �op <br />600 East Main Street, Stockton, CA 95202-3029 <br />SITE MITIGATION <br />Telephone: (209)4G8'34S4Fax: (`OQ)4GQ'433 ' <br />WELL & BORING PERMIT AP <br />PLICATION <br />FORWELLS AND BORINGS USED FORCONTAIMINANT INVESTIGATIONS AND REMEDIATIO <br />NON-REFLINDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED�\�� 3H <br />-—^ <br />----__ <br />_ <br />0'~ <br />app|�^nvn/oxenoymade mSan Joaquin Cnun��ro»o'^'=^='"^`""o'»'mmomuwvmn C^ <br />^"°n"m:«unwo»"ow»montnuo.o»an�,n'��1s».and moSm�mmamribmooen�oonuio -—'~=ith San <br />Site Location He —' <br />" <br />Property �ms aunn' '~/HF4 <br />�w��s�ynz���06 ApwYicps <br />-260 <br />Owner _ CA Army National Guard <br />C-57 Contractor Address~�' o�-M�y�----_-�n����p»vno(916) 369-4327 <br />�. x«o�nu550 <br />on"su/�"oo"bn"t, ---------- River�*�--------- «u''�u��m____�un�1�I9Phone TIE �uu�o» 1777 N. 000mm/oo/,u <br />Billable Party *mu�o,������--------o�����Cc�kuomw p»nnn � <br />=�_- '~ c/w motmer 9 65 369-4327 <br />GIs Coordinates: X 37.884 y -121.247 <br />— <br />------- <br />one <br />__Z MONITORING (See below) M HOLLOW STEM DIA. OF BOREHOLE 8.'/ 10" 0 MULTIPLE CASINGS I@ MULTI-LEvEL WELL CASING DIA: 2" <br />_�!_M EXTRACTION: Vapor/ Water 0 HAMMER/DRIVEN CASING THICKNESS SCH 4_0S9 <br />.—C) SOIL VAPOR PROBE 0 MUD ROTARY DEPTH OF GROUT SE . A I L I Yaries _FI_§DTYPE OF CASING: 0 STEEL ZI PVC 0 OTHER <br />TREMIE TYPE TO BE USED: 91 AUGERS E] HOSE 0 PIPE <br />__0 SOIL BORING 0 PUSH POINT (GPI CPT) GROUT SEAL PUMPED: 9) Yes C3 No (MAXIMUM FREE FALL DEPTH IS 30 FT) <br />_?129 INJECTION 0.9 -Air Sparge, Ozonel 0 HAND AUGER GROUT SPECIFICATIONS <br />—0 OTHER: E3 01 HER APPROX. BORING DEPTH 'Approx 68'max <br />91 BOLTED TRAFFIC BOX OR 0 STOVE PIPE <br />CONDUCTOR CASING 9) No 0 Yes. Casing Dia, —_ Casing Depth: Boring Dia-_ <br />COMMENTS: *Two air sparge well casings will be installed within one 10" borehole (AS-1A/1B) <br />NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS -OR ENCROACHMENT PERMITS <br />DESTRUCTION —WORK TO BE PERFORMED: <br />WELL IDs: 0 OVER -BORE DIAMETER OF — - INCHES TO DEPTH OF <br />EI PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE <br />TREMIE TYPE TO BE USED_._0__A_UG_E_RS__(:] HOSE 0 —pIpE 0 EXPLOSIVES FROM —TO _ FT BELOW SURFACE <br />COMMENTS 0 MUSHROOM CAP AT (a3 FT) FT BELOW SURFACE <br />5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and <br />Signed Titie/company <br />Print Name <br />SITE MAP IN UNIT IV FILE SITE ADDRESS DEPA - RTMENT USE ONLY --Date <br />AppuoArowAccsprsoBv_ <br />GROUT INSPECTION av <br />DESTRUCTION INSPECTION B, <br />uoMMswromnwomomo: <br />PE CODES I FEE INFO <br />AID #��� <br />AMT REMITTED <br />,' _"C` <br />WAE <br />DATE ISSUED <br />FINAL INSPECTION av <br />AREA <br />DATE <br />,'V'D BY <br />DATE <br />SERVICE <br />I R1# <br />INVOICE <br /># <br />°N."S.Gw,tKm// �__swonuAnHMER—TD 0{���A__ <br />LWIN <br />