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.c • San Joaquin County 1 •� <br /> ' Environmental Health Departmer$ �c <br /> _ { 304 Fast Wehcr Avenue, 3rd Floor. Stockton. CA 952 ? L�,(0 SITE <br /> (209)468-3449 Fax:(209)468-3433 Web: www_tjgov.or�r�� 2 MITIGATION <br /> Well Permit ApplicationA(1//�rur5n UNIT IV <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISS f 4ENTSE� �}jj _ <br /> Application is hereby made to San,loaquln County for a permit to construct andlor install the work describ���hi�/app)canon is made in compliance with San <br /> Joaquin County Development Title,Chapter 9-1115,3 and the Standards of San Joaquin County �L <br /> WELL Location 230 industrial Avenue Environmental Health DePartment. <br /> Cross Street 4th Street Cit Ripon• Assessors <br /> PROPERTY ACLU l� --'-- --- y� Z' 95366 Parcel# 25938001 <br /> Owner �e,rfernr i4/� <br /> Atldress P.O.Box 365 <br /> Cry <br /> C-57 Contractor Gregg Drilling, Inc. y Zlp 95366 Pho <br /> ____._.,_Address 950 Howe Road #--------_ <br /> Consultant/ ECM City Martinez Zi 94553 485165 <br /> Sub Cntr 660 Baker Street p `ice Phone*(925)313-5800 <br /> Address Costa Mesa <br /> GIS Coordinates:X Y City— ic# Phone# (714)662-2759 <br /> _ <br /> �_.township—_Range <br /> WORK TO BE PERFORMED: -----__.Section_ <br /> X NEW WELL!BORING (CPT,GEOPROBE,HYDROPUNCH.HAND AUGER,OTH'cR") 8 DESTRUCTION <br /> 0 WELL <br /> BORING# <br /> X WELL#_ :_7 -?(-C"---t (choose type below) <br /> U•Other -4/Q f} /VIES u-) 0 OVERBORE. DIAMETER <br /> Two extraction watts and 3 monitoring wells will be installed. Please attached map URE GROUT <br /> COMMENTS: GROUT SPECIFICATIONS <br /> TYPE OFWELL INSTALLATION TYPE <br /> X MONITORING -- CONSTR CTION SPECIFICATIONS <br /> X HOLLOW STEM _ DIA.OF BOREHOLE_172 # ULTIPLE CASINGS MULTI-LEVEL WELL CASING DIA: _ <br /> X EXTRACTION p AIR HAMMER/DRIVEN CASING THICKNESS Sch.40 6/2" <br /> 0 VAPOR 0 MUD ROTARY TYPE OF CASING: X STEEL X PVC <br /> O AIR SPARGE/OZONE 0 PUSH POINT(GP or CPT)GROUT SEA RPUM ED.L Ye ft boS TREMIE TYPE TO BE USED: 0 OTHER <br /> 0 SOIL BORINGHAND <br /> 0 AUGERS 0 HOSE <br /> p HANDAUGER X 0 No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> 0 OTHER: GROUT SPECIFICATIONS Portland Cement with 5%bentonite <br /> -------._-0 OTHER_ APPROX.BORING DEPTH 70 feet <br /> CONDUCTO ----___X BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> COMMENTS: Extracfion wells will be 6-inch stainless s dnd 6-in PVC riser. monR CASING itoring wells will be 2-inch PVC slotted Screen and riser. <br /> (it YES list specifications in comment section) <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 Ordinances, RUIeS and Regulations, and all applicable California State Laws. <br /> Signed " 7'LG�_ <br /> Print Name iitlelCompanY� m-�'^-i <br /> �FC�113 /I Date <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: <br /> WORK PLAN DATED: <br /> a p <br /> APPlication Accepted By, 0 1 <br /> Grout Inspection B , �"i Date Issued f� <br /> By — _ _ ate 114 � Area <br /> 9 z <br /> Destruction Inspection By �pL_Final Inspection By <br /> COMMENTS i CONDITIONS: E/ � u Date —__DR e_1Ti.�.,•'fw''�.._ <br /> r C <br /> p <br /> ACCOUNTING ONLY: AID# r r C. <br /> PE CODES FEEINFO AMOUNTREMITTED CHECK# FAC# <br /> q z / RECD BY pATE PERMIT!SERVICE REQUEST INVOICE <br /> l O l3 5371 1 13 0? SR# <br /> C-57WC-WAIVER <br /> FND .0 -00i C-5' Letter of Authorization to Sierrniti — <br /> Fi!>-2/04 9n P Encroachment doc <br />