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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br /> <br />SITE <br />MITIGATION <br />UNIT IV <br />WELL PERMIT APPLICATION JUj j200 <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUElDrrn‘,., v v IA! <br />• Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This applic 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 />Assessor's <br />Well Location 821 SOUTH WILSON WAY -4 Cross Street EAST TAYLOR City STOCKTON zip 95202 Parcel # 15131060 <br />Property VICTOR ARANDA Address City Zip Phone # 821 SOUTH WILSON WAY STOCKTON 95202 (209)464 -8675 Owner <br />CASCADE DRILLING 3632 OLMEC CIRCLE C-57 Contractor Address <br />RANCHO CORDOVA 95742 Li7c1# <br /> Phone <br />7510 (916) 638 -1169 <br />City Zip <br />ADVANCED GEOENVIRONMENTAL 837 SHAW ROAD STOCKTON 680227 (209) 467 -1006 <br />Consultant/Sub Cntr Address City Lic # Phone <br />GIS Coordinates: X <br /> <br />, Y , Township Range Section <br /> <br />WORK TO BE PERFORMED: <br />[X] NEW WELL/BORING (CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER") <br />El SOIL BORING# <br />F9 WELL # MW - 5, MW -7, SVE -1 and SVE -2 <br />LI *OTHER <br />LI DESTRUCTION (CHOOSE TYPE BELOW) <br />LI OVER-BORE DIAMETER <br />PRESSURE GROUT <br />GROUT SPECIFICATIONS <br />COMMENTS: Install four on-site wells: MW -5(55'), MW -7(75'), SVE -1& SVE -2 (35') <br />TYPE OF WELL <br />XMONITORING <br />0 EXTRACTION <br />XVAPOR <br />0 AIR SPARGE/OZONE <br />0 SOIL BORING <br />0 OTHER: <br />0 PUSH POINT (GP OR CPT)_ <br />0 HAND AUGER <br /> 0 OTHER: <br />INSTALLATION TYPE <br />X HOLLOW STEM <br />0 AIR HAMMER/DRIVEN <br />0 MUD ROTARY <br />COMMENTS: <br />CONSTRUCTION SPECIFICATIONS <br />, <br />DIA. OF BOREHOLE . 0 MULTIPLE CASINGS 0 MULTI-LEVEL <br />CASING THICKNESS TYPE OF CASING: 0 STEEL XPVC 0 OTHER <br />DEPTH OF GROUT SEAL 31Otoo 7TREMIE TYPE TO BE USED 0 AUGERS 0 HOSE / <br />GROUT SEAL PUMPED: Yes 0 No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />GROUT SPECIFICATIONS I 'ype_ POr+-10-na. Cerne_n .1- , , <br />APPROX. BORING DEPTH 55') 75 35 0 BOLTED TRAFFIC BOX OR 0 STOVE PIPE <br />CONDUCTOR CASING PROPOSED (if YES, list specifications in comment section) <br />Stitte.nthiYviv.,4 X 105-35 3S-S-51 ) 70-7s' <br />LO <br />E <br />WELL CASING DIA: act/ <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 I accordance with San Joaquin County Ordinances, Rules and <br />ReguIations,,a,id all applic le alifornia Laws. <br />Signed ( Title/Company <br />Print Name Netriec L e",--ranza_ <br />SITE MAP IN UNIT IV FILE, ADDRESS: <br />DEPARTMENT USE ONLY <br />. AA 348 C./C.4'Y% <br /> <br />WORK PLAN DATED: <br />APPLICATION ACCEPTED BY <br />GROUT INSPECTION BY —74 <br />DESTRUCTION INSPECTION BY <br />COMMENTS/CONDITIONS: <br />ACCOUNTING ONLY: AID # FAC # <br />PE CODES FEE INFO AMT REMITTED CHECK # RECV'D BY DATE r__.CE # INVOICE <br />3`73 J.:7 7;-Z --ir /-- & . a 5 )51/51i <br />ç/197 -S66;1-Lis 74, kitemeed Geo eT4vin4 <br />Date /1-643 <br />DATE ISSUED <br />6/;"1/4 8 FINAL INSPECTION B <br />DATE <br />C-57 WC -WAIVER C57 LETTER OF AUTHORIZATION TO SIG • - MENT DOC <br />EHD 29-01 11/5/07 WELL PERMIT APP