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SAN JOAQUIN COUNTY ri C u .,_, i {0 L O JUN 2 4 2015 ENVIRONMENTAL HEALTH DEPARTMENT ENVIRGNMENTAi SOP: 1868 Hazelton Avenue, Stockton, CA 95205-6232 PE�?t��lT/SSITEA�7IATION :. . , Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: www.sigov.ora/ehd UNIT IV 4�IFi7R 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. Site Location 8010 S. Airport Way Cross Street Stimson Street City/State Stockton, CA Zip 95206 APN 17726004 Property CA Army National Guard Owner C-57 Contractor Penecore Drilling Consultant/Sub Cntr ECM, Inc. Billable Party CA Army National Guard GIS Coordinates: X -121.247 Y 37.8848 City/State Mather, CA Zip 95655 10260 Mather Blvd. _ Address City/State Woodland, CALic 0906899 _ Address 220 N. Last Street _ Address 3525 Hyland Ave., Suite 200 Address 10260 Mather Blvd. Y 37.8848 City/State Mather, CA Zip 95655 Phone 916-369-4375 City/State Woodland, CALic 0906899 Phone 530-661-3600 City/StateCosta Mesa, CALic #778024 Phone 714-662-2759 City/State Mather, CA Zip 95655 Phone 916-369-4375 CONSTRUCTION WORK TO BE PERFORMED: ® NEW WELL/BORING (CPT, GEOPROSE, HYDROPUNCH, HAND -AUGER, OTHER) ❑ SOIL BORING IDs ❑ WELL IDS © OTHER IDs 28 DPT ISCO injections and 1 SB in 3 total mobilizations. 5 DPT iniection points and one soil boring will be advanced through concrete slab (a)10-12 feet bqs. TYPE & # OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑ MONITORING NI HOLLOW STEM DIA. OF BOREHOLE 3"-6" ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA: _❑ EXTRACTION: Vapor/ Water ❑ HAMMER/DRIVEN CASING THICKNESS 2 TYPE OF CASING: ❑ STEEL M PVC ❑ OTHER ❑ SOIL VAPOR PROBE ❑ MUD ROTARY DEPTH OF GROUT SEAL NIA TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE 1 Rl SOIL BORING IM PUSH POINT (GP/ CPT) GROUT SEAL PUMPED: ❑ Yes ❑ No (MAXIMUM FREE FALL DEPTH IS 30 FT) 28 El INJECTION (Le .Air Sparge. Ozone) ❑ HAND AUGER GROUT SPECIFICATIONS Boreholes will be abandoned with neat cement after completion of injections 171 OTHER: ❑ OTHER: APPROX. BORING DEPTH no greater than 55 feet ❑ BOLTED TRAFFIC BOX OR ❑ STOVE PIPE CONDUCTOR CASING ❑ No ❑ Yes: Casing Dia: Casing Depth: Boring Dia: COMMENTS: First mobilization planned for 6/30/15 for soil boring and punch through concrete slab, injections to begin week of 7/6/15 and second set of injections 8/10/15. 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 (?3 FT) FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulations, and al applicable California laws. Signed —T63—J Title/Company Project Geologist / ECM, Inc. Print Name Chris Drabandt Date 6/23/2015 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE - SITE ADDRESS fig l 5 - Ol,tn h iI t�/G1 WORK PLAN DATED S l S APPLICATION ACCEPTED BY C DATE ISSGIED ZS/ _/ S AREA GROUT INSPECTION BY DATE ��. %<�i f � _FINAL INSPECTION BY/%C6 d' O`DApTE2LL�! j DESTRUCTION INSPECT[ N Y LoA '' L'��/.S�/� / /�i� t✓'r� C%.jx, n�e4��/7 7 r�i'� %C / //� -- '_i YWl COMMENTS/CONDITIONS: /Ltn JT)0�—c ACCOUNTING ONLY: AID # FAC # PE CODES FEE INFO AMT REMITTED CHECK # RECV'D BY DATE SERVICE REQUEST I RO # PR # INVOICE ;Lgo S $`�X _i "z o`t6� (,•� b zs'(rs" SR# 2.53 a9o3 340 -7 3'70-- . o SR; 4-Zf�q - (2 00) S L}oj6 C -57_)C WC WAIVER C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC EHD 29-01 5/09/12 FA 0019323 WELL PERMIT APP ►'%1'1'1% E