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r <br /> Sail Joa'q <br /> k , <br /> Environmental Lealt Department SITE <br /> 600 East Main Street, Stockton CA 95202-3029 <br /> � �F f eK!P MITIGATION <br />{ ` (209) 468-3449-Fax: (209) <br /> 468-3433 Web: www.sjgov.org/eck•.,,. <br /> UNIT I1/ <br /> Well Permit Application <br /> NON-REFUNDABLE PERMIT EXPfRES 1 YEAR FROM DATE ISSUEDN <br />� I <br /> Appiicatjon 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 /> i Joaquin County Development Title,Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Heaith Department, <br /> WELL Location 1930 West Fremont Street Assessors <br /> l Cross Street San duan,Ave Cit Stockton <br /> PROPERTY — y. Zip 95203 Parcel# 133-360-33 <br /> Owner John McDaniel <br /> A.11 Weld Address 1.930 W Fremont St City Stockton `Zip 95203 phone# (209) 839-2501 <br /> ` C-57 Contractor . Abandonment Diamond <br /> [ Advanced Address 6626 Merchandise Way CityS rin 5 Zip 95619 84 <br /> I <br /> Consultant ISub CntrGecEnvironmental 837 Shaw Road p Lic# 8359Phone# (530)644-1609 <br /> l Address <br /> City StocktonLi 680227' ph (249)467-1006 <br /> ' GIS Coordinates;X Y <br /> i Township Range <br /> I WORK TO BE PERFORMED; <br /> FSection <br /> ! <br /> d NEW WELL'BORING (CPT GEOPROBE, HYDROPUNCH, HAND-AUGER,OTHER* <br /> n SOIL BORING# ) DESS RUCTION (choose type below) <br /> i 0 WELL# r� <br /> i �OVER-BgRE. DIAMETER $-1Borehole <br /> (]*Other 0 PRESSURE GROUT <br /> CbMM1=NT5: We11sto be ,ded: MW-1, Mia-2 and MW.3 GROUT SPECIFICATION S Type I1 Portland <br /> TYPE�OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS 1 <br /> MONITORING 0 HOLLOW STEM DIA.OF BOREHOLE <br /> (]i XTRACTION 0 AIR p MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: <br /> HAMMER/DRIVEN CASING THICKNESS <br /> 0 VAPOR Il MUD ROTARY DEPTH OF GROUT -SE�_�TYPE OF CASING: 0 STEEL 0 PVC 0 OTHER: <br /> AL <br /> I <br /> 0 AIR SPARGEI OZONE 0 PUSH POINT(GP or CPT)GROUT SEAL PUMPED: yes s TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE <br /> t 0 SOIL BORING 0 HAND AUGER 0 0 No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> GROUT SPECIFICATIONS- � <br /> 0 OTHER:_�0 OTHER <br /> —�_ APPROX.BORING DEPTH --'TCOMMENTS; <br /> CONDUCTOR CASING PROPOSED_ O BOLTED TRAFFIC BOX or 0 STOVE pjPE(if YES.list specifications in comment section) <br /> i <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT� HMENT PERMITS, <br /> 48 WORKING HOURS NOTICE REQUIRED FOR'INSPECTIONS. <br /> I hereby certify that I have prepared this application and that the work wilhbe done in accordance <br /> County Ordin ces rale d Regulations, and all applicable California State Laws, with San Joaquin <br /> } Signed x <br /> n;! Marty <br /> Title/Com an Vice Pres1 <br /> p Y dent/Advanced GeoEnvirgnmental, Ino <br /> Print Name Robert _Marty <br /> Date <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: E <br /> WORK PLAN DATED: 1L <br /> I 7EDa <br /> Application Accepted ByissuedGrout Inspection Sy Area <br /> Destruction Inspection By / Final Inspection By �— i <br /> e p Date <br /> 1 COMMENTS/CONDITIONS: i <br /> r - i <br /> ACCOUNTING ONLY: AID# <br /> FAC# <br /> PE CODES FEE INFO AMOUNT REMITTED <br /> { i <br /> a1- HECK <br /> CHECK# REC'I)BY DATE <br /> PERMIT]SERVICE REQUEST# INVOICE <br /> c-57Z WC--WarVEa i. a SR# S'4�3� <br /> C-5.7 Letter of Authori <br /> EHD29-02-00I WEB zation tO sign permit✓ Encroachment docl� <br /> { <br /> 9/11/2007 <br /> t <br /> 4 <br />