ARCHIVED REPORTS_MONITORING WELL M-10 INVESTIGATION REPORT 2010

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SAN JOAQUIN COUNTY LOP ENVIRONMENTAL HEALTH DEPARTMENT SITE MITIGATION 600 East Main Street, Stockton, CA 95202-3029 U IT IV • 9.. �; Telephone: (209) 468-3454 Fax: (209)468-3433 Web:www.siciov.org/ehd WELL & BORING PERMIT APPLICATION SEP FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATIOV, NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED y^ N//R0U/NCOU AN1O Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in co 11'A Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health Department. ENT Site Location 142 S industrial Avenue Cross Street E Fourth Street City Ripon Zip 95366 APN 259-39-010 Property contact Binayak Acharya Owner Nestle USA.Inc. _ Address _800 North Brand Blvd City Glendale _Zip 91203 _Phone 661-255-1693_ y - 4A IOC-57 Contractor L n Address City�� sLic q�LPhone E"nage en t. cost 3525 Hyland Avenue,Suite 200 Costa Mesa 778024 Consultant/Sub Cntr hla�ia9en;erjt.Inc. Address City Lic Phone 714-662-2759 Billable Party e r::n„e,:r,i c,,s,Management.Inc. Address 3525 Hyland Avenue,Suite 200 City Costa Mesa Zip 92626 Phone 714-662-2759 GIS Coordinates:X 6381507.6274 Y 2092131.8211 CONSTRUCTION WORK TO BE PERFORMED: ®NEW WELL/BORING(CPT,GEOPROBE HYDROPUNCH,HAND-AUGER,OTHER) ❑SOIL BORING IDs CPT-39(plus an unnamed boring next to the CPT hole for discrete groundwater sampling).Boring location based on ❑WELL IDsRWQCB Approval of June 11,2010 M-1 OA Investigation Work Plan. ❑OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS --j]MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 2" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: ❑EXTRACTION:Vapor/Water ❑HAMMERIDRIVEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ___❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL to surface TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE E3 PIPE ❑SOIL BORING EJ PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) ❑INJECTION 6.e.Air Sparge.Ozone)❑HAND AUGER GROUT SPECIFICATIONS 5%bentonite and cement mix _ ❑OTHER: ❑OTHER: -_ _APPROX.BORING DEPTH _<100 feet bgS ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth: Boring Dia: COMMENTS:Property owned by Nestle. CPT-39 location field selected based on utilities and road access.See attached map. NOTE: OFFSITE WELLS& BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD.(CHECK ALL THAT APPLY) #OF WELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT WELL IDs: ❑PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE GROUT SPECIFICATIONS ❑EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED:❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP AT(?3 FT) Fr BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulations,and all applicable California laws. Signed Title/Company Project Manager, Environmental Cost Management Print Name Bina ak_Aehar a Date August 27,2010 n DEPARTMENT USE ONLY _ SITE MAP IN UNIT IV FIL��E{{-SITE ADDRESS Z?20 T p W It y WORK PLAN DATED_�eJ�/�te: G,�D/D. &6!4QY*'e APPLICATION ACCEPTED BY n DATE ISSUED AREA GROUT INSPECTION BY _ _ FINAL INSPECTION BY _ DATE DESTRUCTION INSPECTION BY DATE COMMENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO# INVOICE REQUEST PR#Q Z I✓ $122 x ( SR#04 OQ-O JI °� RO# 2 0 �w / I 9 C-57 WC WAIVER C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC EHD 29 01 07.28/10 WELL PERMIT APP