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l <br /> SANC J <br /> OAQUIN gF �t S3tCa SYbWS tib£ �°tla iN SG�GSe B�SOL1ii <br /> rrr'�11 SITE MITIGATION WELL & BORING PERMIT APPLICATION RECENED <br /> For Wells and Borings Used for Contaminant Investigations and Remediation Il 10 2011 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED I� <br /> For nn -in. YNNLXi1�1ML NEN,-?l'I <br /> vt' �ti SFi,F.»C_. ....., »f'1 BgyIATMENT <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 Y pIStateRl Second Street Cil Ripon CA 95366 Phone <br /> Cross Street N/A APN <br /> Property Owner- City Of Ripon Phone (209-599-2108 <br /> Address 259 N Wilma Avenue CItylState/Zip Ripon,CA 95366 <br /> C-57 Contractor <br /> Cascade Drilling Technical Services License# 938110 Phone 916-368-1169 <br /> Address 3000 Duluth Street City/State/Zip West Sacramento,CA95691 <br /> Consultant/Sub-Contractor ECM Consultants/Haley&Aldrich License# Phone 661-255-2798 <br /> Address 3525 Hyland Avenue City/State/Zlin Costa Mesa,CA 92626 <br /> CONSTRUCTION WORK TO BE PERFORMED: *Note: ONsite BodngslWells Require Access Agreements or Encroachment Permits <br /> T PEOFWELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> MOM ORING _�❑ HOLLOWSTEM BORING DB'TH 25.5 eet g®BOLTED TRAFFIC BOX ❑STOVE PIPE <br /> ❑ EXTRACTION(VaperNlater) ❑ HAMMERIDWVEN DIAOFBOREHOLE 2inrh ❑MULTIPLE CASINGS❑MULTI-LEVELWELL CASING GA <br /> 44 SOILVAPORPROBE MUD ROTARY CASINGTHICKNESS_TYPEOF CASING: ❑STEEL ❑PVC ❑ OTHER <br /> ❑ SOIL BORING —� PUSH POINT(GP/CPT) CONDWTORCASING ❑Yet ❑No Bong M- Cashg Dior Caerlg Depth: <br /> ❑ INJECTIONWsuaroeomnal ❑ HAND AUGER GROUT SEAL DEPTH TREMIETYPETOBEUSED: p AUGERS ❑HOSE 0PIPE <br /> ❑ OTHER ❑ OTHER GROUT SEALPUMPEOY Cl Yet ❑No (Note:Maxfium Fredel Depth is 30 FQ <br /> WEW SOIL BORING IDs GROUT SPECIFICATIONS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD- (CHECK ALL THAT APPLYF <br /> #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of_feel <br /> WELLIDs ❑PRESSUREGROUT To depth of_feet below surface <br /> GROUTSPECIHCATIONS ❑EXPLOSIVES Fromto_feet beow surface <br /> TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE PIPE ❑MUSHROOM CAP ❑3 feelbelow surface or feetbelm surface if>3 feet <br /> COMMENTS: <br /> 1 hereby eerttty,that I am authorized to oomplets tbls application and that the woTkwgI be done In accordance with <br /> San_Joaquin County Ordinance Codes and Standards,and all other applicable California laws. <br /> Signed �,9 hl Tide/Company Program Manager.ECM Consultants <br /> Print Name Binayak Acharya Date July 3,2019 <br /> EPARTMENT USE ONLY <br /> Application Accepted By: Date Issued: 7 <br /> Grout Inspection By/Dates: <br /> Destruction Inspection By/Dales: <br /> acilitylsile Information <br /> FA Name Address FAILPR# <br /> FA PE WP Reviewed By GGGvvv111 Work Plan Dale <br /> 57 ❑657AatlodeatmfarOWID%OParmit Wodw7s CemP ❑Wed®rs pW iser ment Permit ❑AomaAgreenenl AOawY FR <br /> COM ENTSICONDITION .S /'-., rt f- (J�.Q _ <br /> WPTYPE PE SC FEE INFO ANITREMITTED H RECWDBY DATE WELL PERMIT# INVOICE# <br /> Permit - 01 / $162% r <br /> 1868 E. Hazelton Avenua I Stockton, California 95205 j T 209 468-342 i F 209464-0138 1 wv/w.sjcehd.com <br /> EHD39.0108a1-17 Site MMItation well Penh Aprsicati n <br />