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License# 938110 Phone 916-638-1169 Ext 2331 C-57 Contractor CASCADE DRILLING LP <br />License# Phone 415.706.8935 Consultant/Sub-Contractor ENDPOINT CONSULTING <br />Address 1534 PLAZA LANE #243 City/State/Zip BURLINGAME, CA 94010 <br />EW-1, EW-2, EW-3, EW-4, EW-5, EW-6 <br />DESTRUCTION WORK TO BE PERFORMED: <br /># WELLS TO BE DESTROYED <br />WELL IDs <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY1 <br /> 0 OVER-BORE DIAMETER of inches to depth of feet <br />0 PRESSURE GROUT To depth of feet below surface <br />GROUT SPECIFICATIONS <br /> El EXPLOSIVES From to feet below surface <br />TREMIE TYPE TO BE USED 0 AUGERS 0 HOSE 0 PIPE <br /> <br />0 MUSHROOM CAP 0 3feet below surface or feet below surface if >3 feet <br />par 2ew 0.10 07011. Title/Company ENDPOINT CONSULTING INC. <br />Application Accepted By: iewo Date Issued: ////,- <br />/c/ze.p Grout Inspection By/Dates: Ze/2-7//i 444 ic4( <br />2.9 o 5z, <br />EHD 29-01 10-26-2015 <br />s R 007 465- 4( <br />Site Mitigation Well Permit Application <br />2/1 7 1//7 7537 6/17r/( <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sicehd.com <br />SITE MITIGATION WELL & BORING PERMIT APPLICATION PERMIT/SERVICES <br />For Wells and Borings Used for Contaminant Investigations and Remediation <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <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 />Job Address 8010 SOUTH AIRPORT WAY City/State/Zip STOCKTON, CA 95206 phone <br />APN 177-260-29 7 I 7724_fEl---1I g, 14 1 <br />Phone <br />Address 8010 SOUTH AIRPORT WAY City/State/Zip STOCKTON, CA 95206 <br />RECEIVED <br />OCT 1 4 2016 <br />ENVIRONMENTAL HEALTH <br />Address 3000 Duluth St, City/State/Zip West Sacramento CA 95691 <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits <br />CONSTRUCTION SPECIFICATIONS <br />BORING DEPTH 35 FEET 111 BOLTED TRAFFIC BOX 0 STOVE PIPE <br />DIA. OF BOREHOLE 8 INCH EI MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA <br />CASING THICKNESS SCH 40 TYPE OF CASING: I@ STEEL Pffi PVC 0 OTHER <br />CONDUCTOR CASING 0 Yes 0 No Boring Dia: Casing Dia: Casing Depth: <br />GROUT SEAL DEPTH 15 FEET TREMIE TYPE TO BE USED: E AUGERS 0 HOSE 0 PIPE <br />GROUT SEAL PUMPED? El Yes 0 No (Note: Maximum Freefall Depth Is 30 Ft) <br />GROUT SPECIFICATIONS HIGH TEMP RESISTANT GROUT "SEE ATTACHTED MSDS" <br />TYPE OF WEWBORING <br />0 MONITORING <br />n1 EXTRACTION (VaporNVater) <br />CI SOIL VAPOR PROBE <br />0 SOIL BORING <br />In INJECTION (Air Soarae, Ozone/ <br />0 OTHER <br />NUMBER INSTALLATION TYPE <br /> IR HOLLOW STEM <br />6 0 HAMMER/DRIVEN <br /> 0 MUD ROTARY <br /> 0 PUSH POINT (GP/ CPT) <br />6 0 HAND AUGER <br />0 OTHER: <br />WELL/ SOIL BORING IDs IW-1, IW-2, IW-3, IW-4, IW-5,IW-6 <br />DEPARTMENT USE ONLY <br />Destruction Inspection By/Dates: <br />Facility/Site Information <br />FA Name FA Address FA# eC / Y-2_ / PFUt 6 5-il I 34: j <br />FA PE VVP Reviewed By ,, j, ..(( ,,1 ::e-'7'.* Work Plan Date <br />0 C-57 grK57 Authorization for Other to Sign Permit EK4roCker's Comp 0 Worker's Comp Waiver 0 Encroachment Permit 0 Access Agi tient Et-lead Agency Approval U2(‘R <br />COMMENTS/CONDITIONS: ,V4s-e di h ‘ fi 1,. "te ikleo.1-14e, jre.,,... r <br />SR TYPE PE SC FEE INFO AMT REMITTED CHECK# RECIPD BY DATE SERVICE REQUEST# INVOICE# <br />Permit 290 I '3 ( 3 $139x 5' 1)- 7537 <br />—loco • -26 <br />Cross Street STIMSON ROAD <br />Property Owner* CALIFORNIA ARMY NATIONAL GUARD <br />Signed <br />Print Name SCOTT POLSTON Date 1 0/1 0/1 6 <br />I am authorized to complete this application and that the work will be done in accordance with <br />uin County Ordinance Codes and Standards, and all other applicable California laws. <br />or. by <br />here fy th <br />COMMENTS: <br />THE STEAM INJECTION WELL (IW-1 TO IW-6) WILL USE STAINLESS STEEL CASINGS, WHILE THE EXTRACTION WELLS (EW-1, TO EW-6) WILL USE PVC CASING