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SAN JOAQUIN COUNTY RECEIVED z ENVIRONMENTAL HEALTH DEPARTMENT APR O 3 2017 1868 Hazelton Avenue, Stockton, CA 95205-6232 ENVIRONMENTAL Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sicehd.com PNMCES WELL & BORING PERMIT APPLICATION GUIDANCE MIT/SERVIw�ES A WELL PERM/T MUST BE/SSUED PR/OR TO ANYDRILL/NG OR BOR/NG ACTIVITIES (San Joaquin County Ordinance Code, Title 9, Section 9-1115.3) All drilling and boring activity to identify the presence, absence, or extent of soil or groundwater contamination is to be permitted by submittal of the following completed documents and appropriate fees to the EHD. Drilling and boring activities not associated with this type of investigation are permitted by EHD separately from this process. ITEMS TO BE SUBMITTED: Work Plan. The work plan should describe the site history and the purpose and scope of the proposed investigation. The work plan must include drilling procedures, well and/or boring construction/destruction methods, disposal methods for soil and/or wastewater generated, a site map and a safety plan. For EHD local oversight projects, the work plan must also include sampling procedures and analytical testing methods. Written Approval from the Lead Oversight Agency. Written approval for the work as proposed in the work plan from the lead agency providing oversight for the investigation must be submitted to the EHD(i.e. Central Valley Regional Water Quality Control Board, Department of Toxic Substances Control,etc.). Master File Record Information Form. This form must be completed to identify the site owner name and address, the facility name and address, and the billable party responsible for paying any additional charges associated with the proposed activity. The form must be signed by the individual accepting responsibility for any additional charges. Work Plan/Report Review Activities Fees. The initial work plan fee, as shown below, must be submitted with the work plan to cover the cost of the following activities: work plan/report review, permit review and issuance, waste disposal follow up, notifications and project documentation. A Report of Findings must be submitted to the EHD after all assessment/investigative work has been completed. Work Plan/Report Review Activities Initial*Fees Type of Assessment Project Initial* Hourly Rate Fee Environmental Assessment(no known release) $417.00 (3-hour initial*fee) Other Lead Agency Oversight(CVRWQCB, DTSC, Fed EPA, etc.) $417.00(3-hour initial*fee) Local EHD Voluntary Cleanup Oversight $695.00 (5-hour initial*fee) Hazardous Material Transmission Pipeline $695.00(5-hour initial*fee) *Any EHD staff time spent on the project over the initial minimum hourly fee submitted will be billed to the party identified on the Master File Record form as responsible for additional charges. Well & Boring Permit Application and Inspection Activities. A Well & Boring Permit Application form must be completed and submitted with the appropriate fee for each separate parcel. The Application shall be signed by a C-57 licensed contractor, or the C-57 licensed contractor shall authorize an agent's signature in writing. The Licensed Contractor Declaration must be completed and will be used to expedite license and workers'compensation verification. • On-site drilling by third parties (not the property owner or operator) requires a letter of authorization from the property owner granting permission to drill. • Off-site drilling in public easements or on property owned by another party requires a copy of the encroachment permit or access agreement granting permission to drill on the property. _Well/Boring Permit Inspection Activities Initial*Fees Type of Project Initial*Hourly Rate Fee Soil Borings $139.00/boring (1-hour per boring)up to maximum initial*fee of$417.00(3-hours) Monitoring Wells $139.00/monitoring well (1-hour per mw)up to maximum initial*fee of$695.00 (5-hours) *Any EHD staff time spent on the project over the initial minimum hourly fee submitted will be billed to the party identified on the Master File Record form as responsible for additional charges. Notes: 1.All EHD staff time is charged at the rate of$139 per hour. Make all checks payable to"EHD". 2. If contamination is identified as a result of this investigation, the appropriate agency will be sent a copy of the hazardous waste discharge notification and the site will be so listed on the EHD database. 29-003 Boring Permit APPlication Well&BRequirements 29-00