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v <br /> PQu� San Joaquin County Margaret Lagorio <br /> Environmental Health Department SITE <br /> 304 East Weber Avenue,3rd Floor, Stockton,CA 95202 MITIGATION <br /> (209)468-3449 Fax: (209)468-3433 Web: www.co.san joaquin.ca.us/ehd UNIT IV <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 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 <br /> Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> PG&E Stockton Service Center, Assessors <br /> WELL Location 4040 West Lane Cross Street Enterprise St. City Stockton Zip 95204 Parcel# 135-39-33B-1 <br /> PROPERTY415,973.3773 <br /> Owner PG&E,Robert Gray Address 77 Beale St. City San Francisco Zip 95113 Phone# <br /> C-57 Contractor <br /> Fisch Environmental Address 399 Sherri's Place CityValley Springs Zip 95252 Lick.683865 Phone#209.772.3570 <br /> Consultant/Sub Cntr John Woodruff,PG&E TES Address 3400 Crow Canyon Rd. City San Ramon Lick CEG 1894 Phone# 25,866 5883 <br /> GIS Coordinates:X Lat 37.99 ,Y�Long-121.29 Township 2N Range 6E Section 29 <br /> WORK TO BE PERFORMED: <br /> p NEW WELL 1 BORING (CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER`) p DESTRUCTION (choose type below) <br /> SOIL BORING# Three Geoprobes,'No wells a OVER-SORE. DIAMETER <br /> 0 WELL# a PRESSURE GROUT <br /> 0*Other GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> MONITORING a HOLLOW STEM DIA.OF BOREHOLE 3 in. 0 MULTIPLE CASINGS a MULTI-LEVEL WELL CASING DIA: _ <br /> Q EXTRACTION Q AIR HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: 0 STEEL 0 PVC Q OTHER: <br /> a VAPOR a MUD ROTARY DEPTH OF GROUT SEAL . TREMIE TYPE TO BE USED: D AUGERS a HOSE <br /> a AIR SPARGE/OZONE 8 PUSH POINT(GP or CPT)GROUT SEAL PUMPED: a Yes a No (NOTE: MAXIMUM FREE-FALL DEPTH IS 301) <br /> 0 SOIL BORING i]HAND AUGER GROUT SPECIFICATIONS Neat cement with concrete cap <br /> a OTHER:_G OTHER APPROX.BORING DEPTH 10 feet p BOLTED TRAFFIC BOX or a STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (if YES,list specifications in comment section) <br /> COMMENTS: Three Geoprobes to 10 feet maximum with soil sampling and no groundwater sampling <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordi anees, Rul s a d R guI tions,and all applicable California State Laws. <br /> Signed x Title/Company Geologist Pacific Gas and Electric Company <br /> Print Name Joh oodruff Date J ( i 00 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADD ESS: 40 (4O 0-eUe-n� <br /> WORK PLAN DATED: 0 y t,J �� L}t S'0--Ys 3 t p L{ - 3 A 12- <br /> Application Accepted By �l t� Date Issued -5 a Are y <br /> Grout Inspection By_ 1 Date 3 P3 f U Final Inspection By Date 10 <br /> Destruction Inspection By Date <br /> COMMENTS I CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK# REC'D BY DATE PERMIT 1 SERVICE REQUEST# INVOICE <br /> SR# -3� 3 S <br /> C-57_ WC--WAIVERC-57 Letter of Authorization to sign permit_Encroachment doc_ <br /> EHD 29-02-001 <br /> 9/30/2002 <br />