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0 i—:L <br /> x 6 2005 San Joaquin County <br /> NIT HEALT� Environmental Health Department SITE <br /> r <br /> _.'riVICES. d Fact Weber Avenue,3rd Floor, Stockton, CA 95202 MITIGATION <br /> (209)468-3449 Fax: (209)468-3433 Web: www•.sjgov.orgfchd UNIT IV <br /> d1 rro>i`� <br /> -- NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County for a permit to construct anftr urstall the work described. This application is made in compliance with San <br /> Joaquin Gounty Development Title,Clhe{/a,t,er/19.111115.3 and the Standards of San Joaquin County Environmental Heaah Department- <br /> La'1 U $ ! V X/lY`- �.sgessam <br /> WELL Location ulh of RipamMuni Municipal Ponds Cl StreaWear Stanislaus River City Ripon Tip 95366 Parcal# 25"3N 441 5. <br /> PROPERTY <br /> Owner City of Ripon Address259 N.Wilma City Ripon Zip 95366 Phone# (209)599.2106 <br /> C-57 Contractor Prosonic Corporation,12464 McCann Drive,Santa Fe Springs,CA 90670,Lic# 756217 Phone#480.635.966 <br /> Consultant I Sub Cnir Environmental Cost Management Address 660 Baker St.,Suite 253 City Costa Mesa Uc# Phano# (510)222-2550 <br /> GIS Coordinates:X .Y .Township T 2 S. Rnnga R 8 E. Section 30 <br /> WORK TO BE PERFORMED: <br /> <x NEW WELL/ BORING (CPT,GEOPROBE.HYDROPUNCH,HAND-AUGER,OTHER') a DESTRUCTION (nhwsie type betne} <br /> a SOIL BORING# U OVER-BORE- DIAMETER <br /> X WELL#_M-32G1,M-3202,M-33Ct,M-33C2 3 a, U PRESSURE GROUT <br /> a'Ofher Rotosonic Dnlling GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> X MONITORING a HOLLOW STEM DIA.OF BOREHOLE 19-inch X MULTIPLE CASINGS a MULTI-LEVEL WELL CASING DIA: 21nch <br /> U EXTRACTION a AIR HAMMEWDRIVEN CASING THICKNESS Schad.40 TYPE OF CASING: a STEEL X PVC D OTHER: <br /> a VAPOR a MUD ROTARY DEPTH OF GROUT SEAL 2ft above seal TREMIE TYPE TO BE USED! a AUGERS X HOSE <br /> n AIR SPARGE/OZONE a PUSH POINT(GP or CPT)GROUT SEAL PUMPED: X Yes a No (NOTE: MAXIMUM FREE•FALL DEPTH IS 30') <br /> 0 SOIL BORING a HAND AUGER GROUT SPECIFICATIONS bentonite f cement <br /> a OTHER: X OTHER, APPROX.BORING DEPTH 20D feet g BOLTED TRAFFIC BOX or X STOVE PIPE <br /> CONDUCTOR CASING PROPOSED NO (if YES,list specifications in comment section) <br /> COMMENTS: Two borings with 2 cleated wells In each,fore total of 4 walls,screened between 120 to 200 feet,all on Cily proparty <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> SIG HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby certify t 1 h71e <br /> e re a ed this,}}aapplication and that the work will be done in accordance with San Joaquin <br /> County Ordinanc It a p eg ionsaqd all applicable California State Laws. <br /> Signed T 1eiCompany_Project GeoNI51,f Environmental Cost Management <br /> Prim Name Holly mdorff,P.9i ,,,,.". Date 8&10105 I0 ` yZZ-- ;2- 5-S-0 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: oZ3& T�� rt 12 e. ✓� <br /> WORK PLAN DATED' N AI- <br /> Application Accepted By Date Issued 5 .,,.,Area_. L <br /> Grout Inspection BY iYttit� ..Data_ ? Final Inspection BY /!..-,.-...Data <br /> Destruction Inspection By Date <br /> COMMENTS 1 CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PECODES FFF INFO AMOUNT REMITTED CHECK# RECD BY DATE PERMIT!SERVICE REQUEST 0 INVOICE <br /> E6 0 '$ f� ID cj <br /> C-57_ WC_WAIVER_.� G57 Letter of Authorization to sign permit_Encroachment doc___,_ <br /> i>Hu zr>-D26ot <br />