ARCHIVED REPORTS_MONITORING WELL M-10 INVESTIGATION REPORT 2010

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oAaufly' SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT LOP { SITE MITIGATION �`. 600 East Main Street, Stockton, CA 95202-3029 UNIT IV -., ;:.•':P Telephone: (209)468-3454 Fax: (209)468-3433 Web:www.sigov.org/ehd �rFORN WELL & BORING PERMIT APPLICATION FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDI/�TION AK/O 2p�0 NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED h IN],R�NI/yc� Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in V 0 n Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health Department. I�jF Multiple City of Ripon See next two pages for location M'. _ Site Location Right-of-Ways Cross Street information for each CPT borin Ripon 95366 `"`" "``'° ` m`"` _ 9CIty on P Zip APN "r�rm:i r. a[r-cnecii Property 95366 Owner City of Ripon Address 259 N.Wilma Avenue Cit Ripon Zip Phone 209-599-2108 _._. tom,[1f�1Im; -tom`, t c rt. �A' 9 C-57 Contractor ) Address a City 9s Lic Phone $ rvi nm .:il 'oc. O Consultant/Sub Cntr Address 3525 Hyland Avenue,Suite 200 City Costa Mesa Lic 778024 Phone 714-662-2759 Billable Party Address 3525 Hyland Avenue,Suite 200 City Costa Mesa Zip 92626 Phone 714-662 2759 GIS Coordinates:X - Y - - --11o. There are 19 proposed CPT borings. See next two pages for location information for each of the 19 borings. CONSTRUCTION WORK TO BE PERFORMED: El NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ®SOIL BORING IDs There are 19 proposed CPT borings. See next two pages for name of information for each of the 19 borings. ❑WELL IDs ❑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 191 PIPE ®SOIL BORING EI PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) ❑INJECTION(i.e.Air Sparge Ozone)❑HAND AUGER GROUT SPECIFICATIONS 5%bentonite and cement mix ❑OTHER: ❑OTHER:----- APPROX.BORING DEPTH _ -125'or less ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth:.. Boring Dia: COMMENTS:Exact CPT locations not identified in Work Plan but 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 FTBELOW 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 1 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 Ua„, .. - Title/Company Project Manager, Environmental Cost Management Print Name _ _._Binayak Ach� a Date September 1, 2010 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESS ? WORK PLAN DATED t)vN'C 4,��.''�/O 7 IC,�/I¢C fZ, �/A/jt� APPLICATION ACCEPTED BY �¢�Jl1sG.. rf— DATE ISSUED 7 /O 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 PPR# 2 OS $122 x if Z7— SR#0D660/6o 6 3 3GG 3G RO# 3500 PR# 29000GP0T05( C-57 WC WAIVER _ C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC ��o EHD 240 i 07!28/10 WELL PERMIT APP