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i • <br /> VIV San Joaquin County <br /> Environmental Health Department SITE <br /> �N 1p01 304 East Weber Avenue,3rd Floor,Stockton CA 95202 MITIGATION <br /> 468-3449 Fax:(209)468-3433 Web:www.sjgov.org/ehd UNIT IV <br /> . yME kk <br /> CES Well Permit Application <br /> o <br /> f RMRl� 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 aPPIicafion 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 /> Ripon 95366 Assessors 25932025 <br /> WELL Leoatlon 519 S.Stockton Avenue Cross Street 4th Street City Zip Parcel# <br /> PROPERTY Nestle USA,Inc. <br /> Owner <br /> Address 800 N.Brand BIVd City Glendale,CAzp 91203 phpte# <br /> C•57 Contractor <br /> EnProb Address P.O.Box 8093 G�,Orovill8 Z1095966 UGg485165 P0�(530)589-2019 <br /> 660 Baker Street Costa Mesa,... (714)662-2759 <br /> Consultant/Sub Cmr ECM Address Glyu� Phoria# <br /> GIS Coordinates:X .Y .Tovmship Range _-._—Secfion <br /> WORK TO BE PERFORMED: <br /> X NEW WELL 1 BORING (CPT,GEOPROSE,HYDROPUNCH,HAND-AUGER,OTHER') U DESTRUCTION (choose type bekm) <br /> U SOIL BORING# r 1 �i�y� U OVER-BORE. DIAMETER <br /> — <br /> a <br /> WELL BORING <br /> # e5(�-LA 4 3b'L� C,5 ' +� U PRESSURE GROUT <br /> p,Other f GROUT SPECIFICATIONS- <br /> COMMENTS-Three sol vapor monitoring wells to 5 feet below ground surface wilt be installed. Please see attached map. -_ <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> p MONITORING (]HOLLOW STEM DIA OF BOREHOLES U MULTIPLE CASINGS U MULTI-LEVEL WELL CASING DIA: _ <br /> U EXTRACTION U AIR HAMMERIDRIVEN CASING THICKNESS TYPE OF CASING' a STEEL X PVC g OTHER: <br /> X VAPOR(monitoring) U MUD ROTARY DEPTH OF GROUT SEAL TREMiE TYPE TO BE USED: U AUGERS u HOSE <br /> g AIR SPARGEI OZONE U PUSH POINT(GP or CPT)GROUT SEAL PUMPED: U Yes flNo (NOTE:MAXIMUM FREE-FALL DEPTH IS 301) <br /> a SOIL BORING X HAND AUGER GROUT SPECIFICATIONS <br /> g OTHER: - -- n OTHER APPROX.BORING DEPTH-8 9" X BOLTED TRAFFIC BOX or 13 STOVEPIPE <br /> CONDUCTOR CASING PROPOSED (d YES,fist specifications in comment section) <br /> COMMENTS' <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby Certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances,RulesandRegulations,and all applicable California State Laws. <br /> Signed x _.._fes.It _. Tifie/ComParrY program Manager/Emiranmentai Cost Managdrnent,Inc. <br /> Prim Name BinaVak Acharya _,._ Dale_ I> <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE, ADDRESS: 7 -5 O <br /> WORK PLAN DATED: t1, �A1,� L, LL I t <br /> Application Accepted By 4-,.k +'"-- i^' ✓ Date Issued t D l i Area �I+L,•____ <br /> Grout inspection By Date Final Inspection By Date- 1.1 - <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 I SERVICE REQUEST# INVOICE <br /> SR# uo5 Z3 o S <br /> C-57_ WC_ AVER— C-57 Letter of Authorization to sign permit_ ncroochment doc_ <br /> EHD 29-02-001 <br /> 622/04 <br />