ARCHIVED REPORTS_MONITORING WELL M-10 INVESTIGATION REPORT 2010

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SAN JOAQUIN COUNTY x• �rt'.oG LOP ENVIRONMENTAL HEALTH DEPARTMENT H' ;{ SITE MITIGATION 600 East Main Street, Stockton, CA 95202-3029 A IT IV • ��asR�•�. Telephone: (209)468-3454 Fax:(209)468-3433 Web:WWW.si9ov.orglehd WELL & BORING PERMIT APPLICATION SEP p VED FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDfATtot4f 2OJ� NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED �� /7C�U/NCO i a/OEpgMpFN � Application is hereby made to San Joaquin County for a permit to construct and/or install the work described- This application is made in comp ltsl San Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health Department. Site Location 212 East Main Street Cross Street Nourse Avenue City Ripon Zip 95366 APN 25939017 Property Owner. Ms.Celia Moret Address 807 West 5th Street City Ripon Zip 95366 Phone 209-599-2108 .(/I�-C-57 Contractor 1 Address 1 City Phone La&/y cmironmrlt cost 3525 Hyland Avenue,Suite 200 Costa Mesa 778024 714-662-2759 CoConsultant/Sub Cntr htariapenle[eni III'_ Address City Lic Phone Billable PartyManagrmrnt, Address 3525 Hyland Avenue,Suite 200 City Costa Mesa Zip 92626 Phone 714-66`2-2759 GIS Coordinates:X 6381617.3245 Y 2092117.4603 CONSTRUCTION WORK TO BE PERFORMED: ®NEW WELUBORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ®SOIL BORING IDs CPT-25(plus an unnamed boring next to the CPT hole for discrete groundwater sarnpiing).Boring location based on ❑WELL IDs RWQCB Approval of June 11,2010 M-10A Investigation Work Plan. ❑OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 2. ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: ❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN 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 Ej PIPE El SOIL BORING $I PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) ❑INJECTION 0.e.Air Sparge,Ozones❑HAND AUGER GROUT SPECIFICATIONS 5%bentonite and cement mix ❑OTHER: ❑OTHER: __.._ APPROX-BORING DEPTH __<1100 feet bgs ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth: _ Boring Dia: COMMENTS:Access Agreement attached.CPT-25 location field selected based on utilities and 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) FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify that I 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 Binayak Acharya Date August 27,2010 2 DEPARTMENT USE //ONLY X77D SITE MAP IN UNIT IV FILE-SITE ADDRESS ` dApd/V WORK PLAN DATED_-_-,__ /KIK APPLICATION ACCEPTED BY A E) DATE ISSUED 9?—/— lb AREA GROUT INSPECTION BYFINAL 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# 0-1105 $122 x�I" T/2 ?i 1'( SR# D6DM5p`"I ZAQ 3 3G� �J (300 Z PR# 29 0 600 C-57 WC WAIVER _ _ C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC EHD 29 O1 07!2810 WELL PERMIT APP