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�aPa .co SAN JOAQUIN COUNTY RECEIVEL LOP NVIRONMENTAL HEALTH DEPARTMENT AUG 16 20 SITE MITIGATION y: �• 600 East Main Street, Stockton, CA 95202-3029 UNIT IV ., a�P ENVIRDN�IEMA�:�� 68-3454 Fax: (209) 468-3433 Web:www.sic aov.org/ehd gtiFoa N PERMIT/SENMELL & BORING PERMIT APPLICATION FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is made in compliance with San Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health Department. Site Location 2335 East Miner Avenue Cross Street E Street City Stockton Zip 95205 APN 153-260-44 Property Owner Jerry Henderson Address 14434 Navajo Way City Manteca Zip 95336 Phone Advanced C-57 Contractor GeoEnvironmental.Inc. Address 837 Shaw Road City Stockton Lic 680227 Phone (209)467-1006 Advanced Consultant/Sub CntrceoEnvironmentat,Inc. Address 837 Shaw Road City Stockton Lic 680227 Phone (209)467-1006 Advanced Billable Party Geoenvironmental,Inc. Address 837 Shaw Road City Stockton Zip 95215 Phone (209)467-1006 GIS Coordinates:X Y CONSTRUCTION WORK TO BE PERFORMED: ® NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ®SOIL BORING IDs B1 62, B3 134, 135, B6 ❑WELL IDs ❑OTHER IDs Q TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 1.25" ❑MULTIPLE CASINGS El 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 MAX 50' TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE C4 PIPE 6 SOIL BORING 29 PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes)c No(MAXIMUM FREE FALL DEPTH IS 30 FT) _❑INJECTION(i a.AirSaarge.Ozone)❑HAND AUGER GROUT SPECIFICATIONS Type 1/11 Neat Cement ❑OTHER: ❑OTHER: APPROX.BORING DEPTH 20'and 50' ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth: Boring Dia: COMMENTS: 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 L?