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ME C E I V E OC(OD "f SAN JOAQUIN COUNTY I ENVIRONMENTAL HEALTH DEPARTMEN*PR 1 8 2014 � LOP `• 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION • �;.:�;.;:.�;:4 Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: LTH UNIT IV C�F�µ S WELL & 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. 1Q8 1$p-C�8 Site Location 16777 Howland Road Cross Street E.Louise Ave City/State Lathrop Zip 95330 APN 198 X9-$9 Property Ci J.R. Simplot Corp 16777 Howland Road La95330 09 Owner Address City/State Lathrop Zip Phone2 ( )858-2511 C-57 Contractor Woodward Drilling Address 550 River Road City/State Rio Vista Lic 710079 Phone(707)374-4300 Consultant/Sub Cntr ARCADIS Address 101 Creekside Ridge Court,Suite 200 City/State Roseville Lic Phone (916)786-0320 Billable Party ARCADIS Address 101 Creekside Ridge Court,Suite 200 City/State Roseville Zip 95678 Phone (916)786-0320 GIS Coordinates:X 3 7,aoSG Y —(21r. ),?33 CONSTRUCTION WORK TO BE PERFORMED: H NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ❑SOIL BORING IDs ❑E WELL IDs PW01-230,PW30-230,PW33-90,PW33-150,and PW33-210 ❑OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS 5 ff MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 12-inch 9 MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS sch-80 TYPE OF CASING: ❑STEEL 9 PVC ❑ OTHER _❑SOIL VAPOR PROBE O MUD ROTARY DEPTH OF GROUT SEAL various TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE M PIPE _❑SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED:I@ Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) _❑INJECTION(i.e.Air Soarae.Ozone)❑HAND AUGER GROUT SPECIFICATIONS neat cement ❑OTHER: ❑OTHER: APPROX.BORING DEPTH 105 to 245 feet bgs ❑BOLTED TRAFFIC BOX OR I]STOVE PIPE CONDUCTOR CASING I]No❑Yes:Casing Dia: Casing Depth: Boring Dia: COMMENTS: offsite wells are included in the attached work plan.A separate permit will be applied for when access agreements have been procured. 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?