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PUBLIC HEALTH SERVICIS �oP�U C0 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION N. ` Karen Furst, M.D., M.P.H., Health Officer 304 East Weber Avenue, Third Floor • Stockton, CA 95202 4`'i 6 209/468-3420 ENVIRONMENTAL ASSESSMENTS All assessment activities at a given site are to be documented in reports submitted to San Joaquin County Public Health Services, Environmental Health Division (PHS-EHD) and/or to any other governmental agency performing regulatory oversight. In order to expedite the issuance of permits and field activities the following are to be submitted. ITEMS TO BE SUBMITTED 1. Work plan. It should describe the site's history and the proposed investigation. This should include drilling and sampling procedures, laboratory analyses, well construction or boring destruction method, disposal of soil and/or water generated, a site map and a safety plan. PHS-EHD staff to determine whether the necessary permit(s) may be issued for the proposed work will review the work plan. PHS-EHD will not provide written comments in this review process unless a "No Further Investigation" letter is requested when the investigation has been completed. Please confirm at the time of work plan submittal if it is your intention to obtain PHS-EHD certification at the end of your proposed fieldwork. 2. Master File Record (MFR) Information form. The site owner name and address, the facility name and address, and the party responsible for paying any additional fees must be completed. The individual authorizing the billing must sign the form. 3. Site Mitigation Fees.A fee of$234 (minimum 3 hours of time) must be submitted. Staff time is charged at$78/hour. If more than 3 hours of staff time is required, the party identified on the MFR will be billed for the additional time. 4. Well Permit Application. Complete the Application for Permit form in triplicate and remit an $89 permit fee. The licensed contractor shall sign the Application, or the licensed contractor(Class C-57) shall in writing authorize an agent's signature. a. Off-site well construction in public easements will require that a copy of the municipality's encroachment permit be submitted to PHS-EHD prior to the issuance of the Permit. b. Off-site well construction on parcels of different ownership will require a letter of authorization from the property owner granting permission to drill. c. A separate and complete Application for Permit and $89 fee is required for each differing parcel and/or street address. 5. Reports. The report of the field activities is to be submitted to PHS-EHD as soon as it is released to the responsible party. PHS-EHD will evaluate the findings. If groundwater is impacted, the site will be referred to the Central Valley Regional Water Quality Control Board (CVRWQCB) for possible further investigation. Sites with soil contamination will be evaluated by PHS-EHD to evaluate the need for additional investigation/remediation. A No Further Investigation Letter may be issued if the site warrants. Sites/RPs that do not submit the Report of Findings to PHS-EHD at the end of the investigation will remain on the active database and the party identified as the Billing Party will continue to receive - billing for the time staff accrues in attempting to obtain the required report submittal. A Division of San Joaquin County Health Care Services