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141060 <br />City/State/Zip Woodland, CA 95776 <br /> <br />LiCeese# RCE 86334 <br /> Phone 510-420-2547 <br />48 Hours Advance Notice Required For All Inspections <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. <br />This application is made in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. <br />Environmental Health De v ent <br />3 2017 <br />For Wells and Borings Used for Contaminant Investigations and RemediatioR vjkOW-ivr <br />—COUNTY <br />SITE MITIGATION WELL & BORING PERMIT APPLICATIONS <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />ERkm iris <br />Greatness grows here <br />HEA E41-7. <br />NOV <br />CevED <br />RocEs <br />SANstJOAQUIN <br />City/State/Zip Stockton, CA 95205 Phone NA <br />Cross Street West Lane APN .1.132601.9 7 0 <br />Property Owner* Reyes Coca-Cola Bottling, L.L.C. Phone 847-227-6764 <br />Job Address 1467 El Plnal Drive <br />City/State/Zip Rosemont, IL 60018 <br />License# 906899 <br /> Phone 530-661-3600 <br />Address 6250 N. River Road <br />C-57 Contractor Pen. <br />Address 220 N. East Street <br />Consultant/Sub-Contractor Ramboll Environ <br />Address 2200 Powell Street, Suite 700 City/State/Zip Emeryville, CA 94608 <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br />TYPE OF WELUBORING <br />MONITORING <br />EXTRACTION (Vapor/Water) <br />SOIL VAPOR PROBE <br />MI SOIL BORING <br />INJECTION (Air Sparge. ()zonal <br />OTHER <br />NUMBER INSTALLATION TYPE <br /> 0 HOLLOW STEM <br /> LI HAMMER/DRIVEN <br /> 0 MUD ROTARY <br />4/4-10 PUSH POINT (GP/ CPT) <br />HAND AUGER <br />OTHER: D'mct Posh <br />WELL/ SOIL BORING IDs SB1, SB2, S83, seA <br />CONSTRUCTION SPECIFICATIONS <br />BORING DEPTH so 0 BOLTED TRAFFIC BOX 0 STOVE PIPE <br />DIA. OF BOREHOLE 2 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA <br />CASING THICKNESS TYPE OF CASING: 0 STEEL 0 PVC 0 OTHER <br />CONDUCTOR CASING 0 Yes 0 No Boring Dia: Casing Dla: Casing Depth: <br />GROUT SEAL DEPTH TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE 0 PIPE <br />GROUT SEAL PUMPED? Yes 0 No (Note: Maximum Freefall Depth is 30 Ft) <br />GROUT SPECIFICATIONS <br />DESTRUCTION WORK TO BE PERFORMED: <br /># WELLS TO BE DESTROYED 4 <br />WELL IDs SI31, SB2. SB3, SB4 <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br />0 OVER-BORE--- DIAMETER of inches to depth of feet <br />feet below surface PRESSURE GROUT To depth of <br />GROUT SPECIFICATIONS Neat Cement 0 EXPLOSIVES From to feet below surface <br />0 MUSHROOM CAP 0 3 feet below surface or feet below surface if >3 feet TREMIE TYPE TO BE USED 0 AUGERS 0 HOSE PIPE <br />COMMENTS: <br />er hat I am authorized to complete this application and that the work will be done in accordance with <br />n Joaquin County Ordinance Codes and Standards, and all other applicable California laws. <br />Signed Title/Company <br />Print Name <br />A&YE/(i Date //•g'/7 <br />EPARTMENT USE ONLY <br />Application Accepted By: Date Issued: <br />Grout Inspection By/Dates: <br /> 561 1 S6L 1 5-6,5) cg‘.4 L-)( <br />Destruction Inspection By/Dat s: t3 s-- L- I 4 <br />FA Name ca_c_6__co tc,,,ci FA Address / b 7 Ei pm/Ai FA# ac -z,17, 3 ..6 7 PR# os-3,,z6,0S1/ <br />FA PE <br />74.C° <br />WP,viewed By <br />r--------' <br />Work Plan Date <br />060 C-57 Authorization for Other to Sign Permiteaorker's Comp 0 Worker's Comp Waiver 0 Encroachment Permit 0 Access Agreement 0 Lead A ency Approval 1310‹ <br />COMMENTS/CONDITIONS: 6 cv „, A rme4A- Ix_ t1i4..4-- oufr. L.- 4"-- <br />IDOft 40/e. cit..„...c-N--% r-v, -7,A A.51-- he._ C-crv-ATA;% 1-4A- • <br />WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# <br />Permit vmr -77 $152 x 2) 0-6 OrM P. r----) &kr i`11)003 7 70 6 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />EI-112 29-01 08-01-17 Site Mitigation Well Permit Application <br />kl(161— 74 C6 17 (1° <br />ac) 7