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<br />Application Accepted By <br />Grout Inspection By <br />Destruction Inspection By <br />San Joaquin County Margaret Lagono <br />Environmental Health Department <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.co.san-joaquin.ca.us/ehd <br /> <br />SITE <br />MITIGATION <br />UNIT IV <br /> <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. This application is made in compliance with San <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />PG&E Stockton Service Center, Assessors <br />WELL Location 4040 West Lane Cross Street Enterprise St. City Stockton Zip 95204 Parcel* 135-39-33B-1 <br />PROPERTY <br />Owner PG&E, Robert Gray Address 77 Beale St. City San Francisco Zip 95113 Phone# 415.973.3773 <br />C-57 Contractor Fisch Environmental Address 399 Sherri's Place CityVaiiey springs zip 95252 Lic# 683865 Phone# 209.772.3570 <br /> <br />Consultant / Sub Cntr John Woodruff, PG&E TES Address 3400 Crow Canyon Rd. City San Ramon Licit CEG 1894 Phone# 925.866.5883 <br /> <br />GIS Coordinates: X Lat 37.99 y Long -121.29 ,Township 2N <br /> <br />Range 6E <br /> <br />Section 29 <br /> <br />WORK TO BE PERFORMED: <br />a NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER*) <br />H SOIL BORING # Three Geoprobes, No wells <br />0 WELL* <br />a "'Other <br />COMMENTS: <br />a DESTRUCTION (choose type below) <br />a OVER-BORE. DIAMETER <br />D PRESSURE GROUT <br />GROUT SPECIFICATIONS <br /> <br />TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />O MONITORING a HOLLOW STEM DIA. OF BOREHOLE 3m, fl MULTIPLE CASINGS g MULTI-LEVEL WELL CASING DIA: <br />a EXTRACTION 0 AIR HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: 0 STEEL fl PVC a OTHER: <br />a VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: a AUGERS U HOSE <br />a AIR SPARGE/ OZONE H PUSH POINT (GP or CPT)GROUT SEAL PUMPED: a Yes a No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />SOIL BORING fl HAND AUGER GROUT SPECIFICATIONS Neat cement with concrete cap <br />a OTHER: a OTHER APPROX. BORING DEPTH 10 feet a BOLTED TRAFFIC BOX or a STOVE PIPE <br />CONDUCTOR CASING PROPOSED (if YES, list specifications in comment section) <br />COMMENTS: Three Geoprobes to 10 feet maximum with soil sampling and no groundwater sampling <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordi anc\es, Rul sa dR gulations, and all applicable California State Laws. <br />Signed x<--- it/ <br />Print Name JohrWoodruff <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS: 40 4 es <br />WORK PLAN DATED: 113 0 c---( tA.; t t c S 3 to <br />COMMENTS / CONDITIONS: <br />Title/Company Geologist, Pacific Gas and Electric Company <br />Date iL /7/.001t" <br />Date S )3 Ii0 <br />Date <br />Date Issued <br />Final Inspection By Date <br />ACCOUNTING ONLY: AID# FAC# <br />PE CODES FEE INFO AMOUNT REMITTED CHECK # REC'D BY DATE 131,1114-BERViCETZE NVOICE <br />350 t l'I "rg cl 5 3--2-)— -31'36 1;<,SRttio3 -7 3 <br />C-57 WC -WAIVER C-57 Letter of Authorization to sign permit Encroac <br /> <br />EHD 29-02-001 <br />9/30/2002