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Home My WebLink About2013-206 1 RESOLUTION NO. 2013-206 2 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING AND DIRECTING EXECUTION OF A 3 LICENSE AGREEMENT WITH EQUILON ENTERPRISES LLC DBA SHELL OIL 4 PRODUCTS US FOR AN ENCROACHMENT WITHIN BUSINESS CENTER DRIVE, NORTH OF HOSPITALITY LANE WITHIN THE CITY, FOR THE INSTALLATION 5 OF THREE GROUNDWATER MONITORING WELLS. 6 BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AS FOLLOWS: 7 8 SECTION 1. That the Mayor and Common Council of the City of San Bernardino 9 hereby approves a License Agreement with Equilon Enterprises LLC dba Shell Oil Products 10 US for an encroachment within Business Center Drive, north of Hospitality Lane in the City 11 of San Bernardino, for the installation of three groundwater monitoring wells. 12 SECTION 2. That the City Manager is hereby authorized and directed to execute on 13 14 behalf of the City said License Agreement, a copy of which is attached hereto and 15 incorporated herein as Exhibit"A". 16 SECTION 3. The authorization to execute the above referenced license agreement is 17 rescinded if the parties fail to execute it within ninety (90) days of the passage of this 18 Resolution. 19 20 /// 21 /// 22 /// 23 24 25 26 27 28 2013-206 1 RESOLUTION OF THE MAYOR AND COMMON COUNCIL OF THE CITY OF SAN BERNARDINO AUTHORIZING AND DIRECTING EXECUTION OF A LICENSE AGREEMENT 2 WITH EQUILON ENTERPRISES LLC DBA SHELL OIL PRODUCTS US FOR AN ENCROACHMENT WITHIN BUSINESS CENTER DRIVE, NORTH OF HOSPITALITY LANE 3 WITHIN THE CITY, FOR THE INSTALLATION OF THREE GROUNDWATER MONITORING WELLS. 4 5 I HEREBY CERTIFY that the foregoing Resolution was duly adopted by the Mayor 6 and Common Council of the City of San Bernardino at a joint r-gul ar meeting 7 thereof, held on the 15th day of July , 2013, by the following vote, to wit: 8 Council Members: AYES NAYS ABSTAIN ABSENT 9 10 MARQUEZ x 11 JENKINS x 12 VALDIVIA x 13 SHORETT x 14 KELLEY x 15 16 JOHNSON x 17 MCCAMMACK x 18 19 Georgil Hanna, ty Clerk 20 1�3- The foregoing resolution is hereby approved this l t day of July , 2013. 21 22 23 'atric J. Morris, • •r 1 ' of San Bernardino 24 Approved as to form: 25 JAMES F. PENMAN, 26 City Attorney 27 By 28 2013-206 LICENSE AND AGREEMENT THIS LICENSE AND AGREEMENT is made and entered into this 15th day of .Tuly , 2013, ("Effective Date") by and between EQUILON ENTERPRISES LLC dba SHELL OIL PRODUCTS US, hereinafter referred to as "Licensee," and the CITY OF SAN BERNARDINO, a municipal corporation hereafter referred to as "City." WITNESSETH: For and in consideration of the mutual promises and covenants herein contained, the parties hereto do hereby agree as follows: 1. City hereby gives permission, removable and terminable as hereinafter provided, to Licensee for encroachment of three (3) groundwater monitoring wells and appurtenances thereto ("Wells") to be located in, under, along and across Business Center Drive, north of Hospitality Lane, a public street in the City of San Bernardino, as shown on the plat attached hereto as Attachment 1 of Exhibit "1" ("Encroachment Area") and incorporated herein by reference in accordance with that letter dated April 9, 2013, from Conestoga-Rovers & Associates, a consultant for and on behalf of Licensee, as set forth in said Exhibit "1", and subject to any requirements or conditions as may be imposed by the Director of Public Works of the City, or his/her designee. 2. Use of said Encroachment Area shall be for the right to construct, maintain, inspect, operate, protect, repair, replace and retain in place the Wells as indicated schematically on Attachment 2 of said Exhibit "1". Licensee agrees to install, use and maintain said Encroachment Areas required by this Agreement. All Wells installed, located or maintained pursuant to this Agreement shall be so placed and maintained as not to interfere 1 of 8 2013-206 with the use of any public street, highway, alley or bridge by the traveling public to any greater extent than is reasonably necessary, and the placement of any Wells shall be subject to approval of the Director of Public Works so as not to interfere or conflict with any existing or future storm drain, sewer, water line and any other utility or improvement owned by the City. In installing, replacing, repairing or maintaining said Wells, the Licensee shall fill all trenches and leave the surface of said streets, highways or alleys in as good condition as it was prior to excavating for said installation, replacement, repair or maintenance to the satisfaction of City, and shall comply with any and all Federal, State and local laws, rules and regulations applicable thereto, including the requirement for obtaining street cutting permits. Street cuts, temporary encroachment permits and restoration of street cuts shall be completed pursuant to City Standard 310 and subject to the requirements as set forth in Chapter 12.03 of the City of San Bernardino Municipal Code. 3. Licensee has obtained Well Permits from the County of San Bernardino, Department of Public Health, Environmental Health Services, a copy of which is shown in Attachments 3-A, 3-B and 3-C of said Exhibit "1", for the purpose of installing said Wells. Licensee shall keep said permit in full force and effect during installation of said Wells. 4. The Encroachment Area shall be maintained at all times in a safe, neat, and good physical condition. City shall be the sole judge of the quality of maintenance, and upon written notice by City, through its Director of Public Works, stating in general terms how and in what manner the maintenance is required, Licensee shall be required to perform such maintenance. If Licensee fails to do so, then City shall have the right to perform this maintenance, the cost of which shall be borne by Licensee. Licensee shall, at its own responsibility and expense, obtain and keep in effect all licenses, bonds, insurance and permits necessary for the installation and existence of said Wells and Encroachment Area. 2 of 8 2013-206 5. City reserves the right to improve, widen, vacate or relocate any highway, street, alley or other public place, or portion thereof, over and within which this License and Agreement is granted, including the widening, change of grade, construction or reconstruction of such highway, street, alley or other public place or portion thereof, for the purpose of any public improvement. If notice is given by City to Licensee that work is to be done pursuant to the rights reserved herein, which notice shall specify the general nature of the work in the area in which the same is to be performed, Licensee shall at its expense, do all things reasonably necessary to protect, disconnect, relocate or remove its property during the progress of such work at the required time in order to accommodate such work. All such things to be done and work to be performed by Licensee shall be at the sole cost and expense of the Licensee. In the event that City shall hereafter construct, install, reconstruct or repair any bridge or artificial support in, on, over or underlying any highway, street, alley or other public place or improvement in which the Licensee's property is located pursuant to this Agreement, and in the event that the cost of such work by City as may reasonably be required is increased in order to provide for the installation, maintenance or operation of Licensee's property in, on, over or under the area covered by such project, then Licensee shall pay to City the full amount of such increase in cost, upon completion of such construction, installation or repair. Any damage done directly or indirectly to any public street, highway, alley or other public place or improvement by the Licensee, in exercising directly or indirectly any right, power or privilege under this Agreement, or in performing any duty under or pursuant to the provisions of this Agreement, shall be promptly repaired by Licensee at its sole cost and expense, to the reasonable satisfaction of City. 6. Licensee hereby acknowledges the title or paramount interest of City to the public right-of-way and agrees never to assail or resist said title or interest and to observe 3 of 8 2013-206 present or future set-back requirements relating thereto while this Agreement is in force and effect. 7. Licensee shall, as and for the consideration for the granting of this License, pay to the City of San Bernardino, forthwith, the sum of$625.00 due immediately upon approval of this Agreement by the City. This Agreement shall not take effect until such payment has been made by the Licensee to the City. Licensee shall also make an annual payment of $150.00 to the City which shall be due and payable on January 1 of each year while this Agreement is in effect. 8. City reserves the right to terminate this License Agreement at any time for any reason by giving Licensee at least thirty (30) days written notice of such termination, except that City may, at its election, terminate said permission forthwith at any time if Licensee shall fail to comply with or abide by each and every provision herein or keep each and every one of Licensee's promises herein. Waiver by City of any breach of any term or provision hereof shall not be deemed a waiver of any subsequent breach of the same or any other term or provision herein. If not otherwise terminated, this Agreement shall be for a term of five (5) years commencing on the Effective Date of this Agreement and ending five (5) years from that date. 9. This Agreement may be extended for any additional terms upon the recommendation of the Director of Public Works and by written mutual consent and approval by the Licensee and the City Manager. 10. Upon termination of this Agreement, Licensee agrees to immediately remove said Wells from the public right-of-way and to restore the public right-of-way to the satisfaction of the Director of Public Works. If Licensee fails to exercise its duties under this paragraph, City shall have the right to remove said Wells and Encroachment Area and to 4 of 8 2013-206 restore the premises at no cost or liability to the City. Licensee covenants and agrees to reimburse City for such cost of removal and/or restoration. 11. City shall in no way be responsible for loss of or damage to said Wells or for any property belonging to or leased by Licensee, its officers, servants, agents or employees, that may be stolen, destroyed or in any way damaged during the installation, use or maintenance of said Wells and Encroachment Area. 12. Licensee shall exercise its privileges under this Agreement at its own risk. Licensee shall indemnify, defend and hold harmless City, its elective and appointive boards, commissions, officers, agents and employees from any costs, claims, damages, injuries, and liability resulting from, arising out of, or in any way connected with, the City's approval of this Agreement, the construction, installation, use or maintenance of said Wells and Encroachment Area, the occupation or use of the public areas of such structure, both during and after the installation thereof, and including but not limited to any costs, claims, damages, injuries, and liability arising from the acts or omissions of Licensee or the employees, invitees, guests or agents of Licensee in the performance of any work authorized herein. 13. While not restricting or limiting the foregoing, during the term of this Agreement, Licensee shall maintain in effect policies of comprehensive public, general and automobile liability insurance, in the amount of $1,000,000.00 combined single limit, and statutory worker's compensation coverage, and shall file copies of said policies with the City's Director of Public Works prior to undertaking any work under this Agreement. City shall be set forth as an additional named insured in each policy of insurance provided hereunder. The Certificate of Insurance furnished to the City shall require the insurer to notify City of any change or termination in the policy. 5 of 8 2013-206 14. This Agreement is personal to Licensee. It is non-assignable, except with prior written consent of the City. Any attempt to assign this Agreement without consent will terminate the privileges granted to Licensee under this Agreement. The City will not unreasonably withhold consent. 15. This Agreement shall be governed by and construed and interpreted in accordance with the laws of the State of California without regard to principles of conflicts of law. The parties hereto further agree that all actions or proceedings arising in connection with this Agreement shall be tried and litigated in the courts located in the County of San Bernardino, California. The aforementioned choice of venue is intended by the parties to be mandatory and not permissive in nature. 16. In the performance of this Agreement and in the hiring and recruitment of employees, Licensee shall not engage in, nor permit its officers, employees or agents to engage in, discrimination in employment of persons because of their race, religion, color, national origin, ancestry, age, mental or physical disability, medical condition, marital status, sexual gender or sexual orientation, or any other status protected by law, except as permitted pursuant to Section 12940 of the California Government Code. 17. In the event that litigation is brought by any party in connection with this Agreement, the prevailing party shall be entitled to recover from the opposing party all costs and expenses, including reasonable attorneys' fees, incurred by the prevailing party in the exercise of any of its rights or remedies hereunder or the enforcement of any of the terms, conditions, or provisions hereof. The costs, salary and expenses of the City Attorney and members of his office in enforcing this Agreement on behalf of the City shall be considered as "attorneys' fees" for the purposes of this Agreement. 6 of 8 2013-206 • 18. All official notices relative to this Agreement shall be in writing and addressed to the following representatives of Licensee and City: City: Licensee: CITY OF SAN BERNARDINO EQUILON ENTERPRISES LLC dba Department of Public Works SHELL OIL PRODUCTS US Real Property Section 20945 South Wilmington Avenue 300 N. "D" Street, 3rd Floor Carson, CA 90810 San Bernardino, CA 92418 Shell Program Manager: Andrea Wing Ph: (909) 384-5140 Ph: (714) 731-1050 Fax: (909) 384-5190 Fax: (714) 731-1038 19. This Agreement may be amended only in a writing signed by the parties in interest at the time of the amendment. No amendment shall be binding upon City unless formally approved by a vote of the Mayor and Common Council of the City. 20. This Agreement constitutes the entire Agreement between the parties with respect to any matter referred to in this Agreement, and supersedes any and all other writings and oral negotiations with respect to any matter referred to in this Agreement. The terms of this Agreement shall prevail over any inconsistent provision in any other document relating to this Agreement, including exhibits to this Agreement. /// /// Signatures to follow on next page 7 of 8 2013-206 LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN BUSINESS CENTER DRIVE, NORTH OF HOSPITALITY LANE; IN THE CITY OF SAN BERNARDINO,CA. IN WITNESS, the parties have executed this Agreement on date first written above. CITY OF SAN BERNARDINO: EQUILON ENTERPRISES.LLC dba SHELL OIL PRODUCTS US: ALLEN J. PARKER, City Manager Print Name/Title: Approved as to form: JAMES F. PENMAN, City Attorney By: .� -D 8 of 8 2013-206 eRA 175 Technology,Suite 150, Irvine,California 92618 Telephone: (949)648-5200 Fax: (949)648-5299 www.CRAworld.com CONESTOGA-ROVERS &ASSOCIATES April 9,2013 Reference No.060675 City of San Bernardino Public Works Department-Real Property Section Attn:Ryan Sandoval 300 North D Street-3rd Floor San Bernardino,CA 92418 Dear City of San Bernardino Public Works Department-Real Property Section: Re: Encroachment/License Agreement Request for Monitoring Well Installation Shell branded Service Station 1930 South Waterman Avenue San Bernardino,California RWOCB-SA Case No.2002025 Conestoga-Rovers&Associates,Inc. (CRA),on behalf of Equilon Enterprises LLC dba Shell Oil Products US(Shell),requests an encroachment/license agreement to install three groundwater monitoring wells on Business Center Drive in the City of San Bernardino(City) right-of-way. The wells are being installed to gauge and monitoring groundwater for California Regional Water Quality Control Board-Santa Ana Region(RWQCB-SA)Case No.2002025 at 1930 South Waterman Avenue,San Bernardino,California. The wells will need to remain in place as long as the RWQCB-SA case is open. This letter is being sent in response to the email received by the City on February 26,2013,a copy of which is attached hereto. The City requested that we obtain approval from the City's Water Department for the wells;this approval email is also attached. The City is already in receipt of the permit application,which was submitted to Darren Hall via email on February 21,2013. As requested,CRA has also attached the following: 1. a CRA Site Plan showing the well locations, 2. a well surface diagram, 3. a copy of the County of San Bernardino well permits,which contain additional well construction details, 4. Certificates of Insurance,and 5. a check for fees ($683.50). Equal EXHIBIT IC �� Employment Opportunity Employer t Worldwide Engineering,Environmental,Construction,and IT Services 2013-206 eRA CONES OGA ROVERS &ASSOCIATES Reference No.060675 April 9,2013 -2- CRA is the environmental consultant for the well owner,Shell. Please make the Encroachment/License Agreement in Shell's name. Shell's information is provided below: Equilon Enterprises LLC dba Shell Oil Products US 20945 South Wilmington Avenue Carson,CA 90810 Shell Program Manager:Andrea Wing Phone: (714) 731-1050 Fax: (714)731-1038 CRA appreciates the opportunity to work with you on this project. If you have any questions, please contact CRA Project Manager,Angela Ribeiro,at 949-648-5211. Respectfully Submitted, CONESTOGA-ROVERS&ASSOCIATES Angela Ribeiro DC/cg/1 End. City Real Property Section Email Requesting this Letter (dated 2/26/2013) City Water Dept.Email Approving Wells (dated 2/26/2013) Site Plan Well Surface Diagram County of San Bernardino Well Permits Certificates of Insurance $683.50 Check for Fees cc: Andrea Wing,Shell Oil Products US(Livelink) • •a ', Worldwide Engineering,Environmental,Construction,and IT Services 2013-206 0 30 6011 111•1;■;0•••111 LIL BURN CORP. 1.21z. 0 CPT-10 CPT-17 13 a CPTT ... -23 \\ CCS•FORT -'66, 0 ''.. '77 tr. 'S. INN MOTB. a CPT-22 POOL •S83(MII.17) WELLS TO BE INSTALLED MW 20 Ot< IN CITY RIGHT-OF-WAY 0 CPT-24 0 CPT.21 COMPORT SB-2 INN ..MN1.14 1 61.0TA. —1 •M1N-12 CPT-20 •".1 0 CPT-18 0 CPT-14 0 CPT-13 0 CPT-12 ..../ 0 ...... BEST —.I WESTERN --___A mw.21 0 MOTEL 0 ION13 — / / ---- 1 11 1 I 1 1 ' 11C1" 1 . ,---- i .al I ..---- 1.4j. ,C = MW-16 PT-15, PARKING OPT-10 criLts.0 AREA 'IL C:1 4 4 ,...... 1 T 1 1 gi 174' C Pr.7 1 1 i t; -- • "" :,I ..c,,. 7111.1-4 TT-- ...„.:, MW-22 6 — Rems-4•1:1 10'3 0-0-1 1 ID 0 0 PZ.4 1 0 0■1 11.0.4 0 PZ..2 till BEST 1°-.1 • .4111 ,....„'Hip MW:-2 a t 4 / " ie,.. 7 1 sTERN —.. • IS tom 1 oiseeriseR .....,..;Ir...,;,.....-,.....-8&,2 . As .. •., .,all, ....,.,...,,,,0 CI" SK:' 3, ,... us.) . J-- O fl CB-3• „, 111 -,/IF V•MW1 1 7ANOPY POOL AREA MW.2• / HOSPITALITY LANE - - - —...... .iit /'----------- -'1 r SIDEWALK '\ 1 SIDEWALK -.....,, LEGEND mw-l• MONITORING WELL LOCATION PZ-1• PIEZOMETER WELL LOCATION 10-1 0 02 INJECTION WELL LOCATION CB-1• SOIL BORING LOCATION PROPOSED WELL LOCATION MAP CPT-1 In CPT SOIL BORING LOCATION SHELL-BRANDED SERVICE STATION :311.1* FORMER GROUNDWATER MONITORING WELL LOCATION 1930 SOUTH WATERMAN AVENUE , Or PROPOSED MONITORING WELL LOCA11014 1 (2F) San Bernardino, California ..1 wars-won tromwooz.ma 412a15 , / I . . . 1 ATTACHINIENT 1 2013-206 APPLICATION FOR WELL PERMIT s,� s"8"94414.1'::,.r,`".;:1;:":''',:, ,,,pp {, �� z e `s"^ w �''` 1N�b7�; 'lu,,-,;.!"r.'. ,..b: County of San Bernardino � �i";s. :` k,� tea, .1.i0.3:0.4". r., s � _ ti :«�.� " �, Department of Public Health 'r ,°; r 6= .� �*`tip;°5�>' . � ;; . `, x DIVISION OF ENVIRONMENTAL u� y�^' �" m" "a �, 'a �. '' HEALTH SERVICES " V +, f r l' ;! +a rate r dN ``'cE '.' 0 "zS� t ��,� Phone:(800)442.2283 . IQt;r1"2, ;;�,,.` 'in• , ' rt r". , a att www.sbCOUnty.covJdehs_ ,,,0.t,14' ' X a/s r 4^'1r 1r.,, . pp y.Y `"1 i; "at i1 k "s w" h t" e 4i'40■ i tl , t„.i{"fi a ^ °W r rr w t ", (Pleasepri°0 (M,�I•,V-Z x� ,. !' , u S j Items 6 through 9 to be eslfmated for n„wells,exact for all other Ws ells ft. 1. OWNER:Name -ovw. .l p 1 ,,, ' . ANNUALAR SEAL Seal Depth "11 Site Address \ 3n�-urn s -Ave.-Ave Furnished by: ❑ Owner Contractor in.,Wall Ga e Q Driven Conductor Dia. ( g in City '�i�� (1t��]AtC�►iY�7Zip � d Sealing Maternal �ickness /y,,,, ,, Sealing material shall be Rlalcedln one continuous pour. Mailing Address '4f5 S_ 1d1i �YV111i Vt "�'�� l3. DEPTH OF WELL(feet):. ' () - � r Existing Proposed City Zip -- p 4 DIAMETER OF BORE(in.): B Telephone Number ('1‘141 O50 7 CASING INS easing standard kt r:;� ❑Steel g F' ❑Standard casing ❑Other OA 2. WELL DRILLER: " f, From(ft.) To(ft.) Dia,tin.) Wall(Gage) 0,2,1058,12-0t3 t>3 rt3 , acre # sr WO ttin Pack:�,Yes ❑ No . c , 3. • INTENDED.WELL USE(check): From�' -'3 tom -ft.., ❑Agricultural ❑Horizontal ❑ 1' xval❑Cathodic Monitoring/Observation g_ PERFORATIONS(if applicable}: C. X1❑Residentiat Commun"cty/PWS/City ❑Ote ft. Mining From S to ❑Industrial ❑Geotheimaf Punping'rate(gprrt) 4. TYPE OF WORK(check): 9. SFALEDZONI=S'�(llapplrcable):;.• •�± ,, VI New ❑ Reconstruction ❑ Destruction From `to -`., "7 `" i Scale t Ir�clt mile s.'_: SECTION MAP—Dt},Nt7TFlt!M 0. LOCATION INFORMATION. + i (a) Tt WNSHIPs ' .2- Tier _. N SEtange� E / eclicn �- 't i (b) Asse$ sSarc-el Nb. Oi4414121b 0000 NV1! y4 a, NE % (c) •Latitude and Longitude Let: t O ', 5.43 2°t Long: ll ' (d) Solid or Liquid Disposal Site within miles `~ f$ Yes ❑ry No `�`0,�1 "s •. ....---170"--..r ` }�1'".sw L C$tle � �-)? ''3AA. ,, ,_ ' :'at5<.. g $ ,c IC i S Id _ t,Y1 ' 6 iu 6 .L p'!1S.fy M'A Y4� 4'.� B i pc: °P6 i 1 „s,''2a' 1 51 " serrxila t ..i'l. ;"�l lir'' 2 °�.� .%'; a� n # .s ' v,t ,n n,. SW ryy "¢ a m ,S ,y n;, ,,e"" . - -. . ;• 64'(� rat V ,c,r .+h ki it R^x ?,r s 4xt4" . i,,i"r,r i1 ('fl £ y I !�r }i�'i �a��t t V''nx 4 t .�!.t . '' M---^- " 1/15/13 , , Page 1 of 2 ,"1 I ATTACHMENT 3-A 2013-206 , . . . . . . . . 11. PLOT KAN: .r;..r.. er 2MA0Orytitt;),%3‘ke.Vrah Assatraor's Parcel NO. ,D‘Lit eli z.1.6*0 CO C') (2) ti,par-op- .ter the welt/kb,oath sodlabeithe al foowing babe:atoll ion properly NUN.alherNds l 141 anude abandoned Wlls),sewage disposal syrderns(ionverh arretfolanfot kraidergifoldh t4-4-1/3—2'1) . seepage Oh corePors),Me*and ponds. watercourses and animals or fowl kept . i ,kee. —------... ...-.„. (o) Indicate the distance,In feet,of arty of tha following which we within 5001 of the well Site: ,Z•ktlatolVe-C4 '''''' ..,,.. • S tati . e .,,` • Crbrioreort Other . . r• Sewers Sepeotanks ., • 1 I t ,.. t Leaching folds ; ,", , , : I I .---- si, , • Seefgflo Os . yr I • /I • 1 `1,•\ 1 , I a e A • ,, r A I cesspoots I 1 /. E W t , i I , I — i I Lakes and poeds 1 . It, , _I, . ■ Slte , r • I , 1 ) , ,, , .. , . - ; ' • - . i . , '',,t. / i 1 co r A c rk. Watercourses . , . * ,........ i ., 1 , .• . 0 1,„tv, --vif -4tVs.r. /VA 1 - . Animal or fowl kept . "... • .1,,, . • e"...oi OtekaUsi'‘' \ \ a 414 , 0 ,,,,. i Using an smart show the appordmare . s'...., e , dndriage pattern clews property and show ' aopess roads to the web site within 600 . • ''''".- :a W 0/ I '''' e, 1ArIv feet .f ,4,.,,,_..,,. ''''''• , . ..' at(..A1-...c. 4--. ‘.• A ----- (c) ... of the strove are within 600 feet of the. well she. ' • Seale;*arch.g100 aser S ••ftrcornproar a•pircarraors wet be returned." 12. 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' „oil, Page 2 o12 1115113 . , . ■ . . , .. 1 —t—-- -- • 2013-206 FLUSH-GRADE TRAFFIC RATED WELL BOX _ CONCRETE PAD 12"-0.1 1.5'TO 2'DIAMETER � ` .; OR SQUARE -i f3 $t r; .'t 111111"111.11' Cr is x ; '14W-t4 ATtela " CONCRETE :>. 2"DIAMETER 0-1 FBG yr SCHEDULE 40 PVC CASING BENTONITE GROUT II Imo---8" NOTES_ FBG=FEET BELOW GROUND NOT TO SCALE. MONITORING WELL SURFACE DIAGRAM PROPOSED WELLS ON BUSINESS CENTER DR Shell-branded Service Station 1930 South Waterman Avenue R h San Bernardino, CA LAST UPDATED BY DCOBB 2/20/2013. .44 ATTACHMENT 2 2013-206 APPLICATION FOR WELL PERMIT st. ' 3547 �'� x`"1�rw� DMZ , QN&Y a,,,i� ,,,: County of San Bernardino A. },,� , -;- +� , , : I... ';'�rt ,gtlyi% etr —,,tA1;;, Department of Public Health ,....1 ,Z 7 t�w77,r 6tir t n-..'"1.,:,,I;71,,s " f j ' '`a' DIVISION OF ENVIRONMENTAL , Q S;1, '� ° .• :..;;.;:.1.4.1,.! c'r. vm:x3 5'1. .�..- .� .�� HEALTH SERVICES ; �" Aft7ceog,.aki.04,1*4.k.,.!. { i. ti . �� ' `' 1;� Phone:(800)442-2283 'x a .x}+�a +cf.n,Ssd? r 3 iA.; s`4 �".4., . * -i �t r 147ti yarww.sbcount+l.govldehs � a ," v,%` :f r 7-W le .4 ' ,s r t"' �r$ O C�'8'. (Please print) ( "Gi Ile t L .. r.P items 6 through 9 to be estimated for new wells,exact for all other wells ft. 1. OWNER:Name �a.'. �j • ANNUALAR SEAL: 'Seal Depth . "'IX 1f IrVlr a L '- Furnished by: ❑ Owner Contractor Site Address 9 S E ❑Driven Conductor Dia. in.,Wall(Gage) q � Thickness in- Searing material shall tea placed In one continuous pour.. Mailing Address 24.‘,... .-_____.1� S Gt1l1ml - 6. DEPTH OF WELL(feet): CID-i g it) Proposed Existing City + CGyl Zip DIAMETER OF BORE(in.): Ql Telephone Number 1 ► �3 .. s; standard �r . 7 CASING INST 0O: a ❑Steel 1 c ❑Standard casing ❑Other 2. WELL DRILLER: ■ ® • From(IL) To ft.) Dia.(In.) Wall(Gage) 0305 Wt.& 03 ,3213 Steil DRNe Coal ' 3 1 PacicVI Yes ❑ No `�h ft. 3. INTENDED WELL USE(check): From " ?i to ❑Agricultural ❑Horizontal ❑Test {Y 1 'YVc3 ❑Cathodic MonitoringiOhservation [11 Dairy 8. PERFORATIONS(If applicable): Screen ❑Residential CommunitylPWS/Cull ❑Other From 5 to 0 ft. ❑Industrial ❑Geothermal ❑Mining Pumping rate(gpm) m? 4. TYPE OF WORK(check): Destruction 9. SEALED ZONES(if applicable): rx._ .�18w El Reconstruction. ❑ From _ to __= . — fG SECTION MAP-DO NOT FILL iN Scaaloflnch-°' mile' 10. LOCATION INFORMATION c (a) TOWNSHIP: .c ° Tier I NeRange `t F- ctltsn "T2 (b) Asseao Par No. o lgti l'Z t5P QP MN % 47 NE Y4 (c) Latitude and Longitude Lat: U Zit '"' c+4, :., •> '- '' :. . ::. Long 1I'1 r 41'S-t1 C� G C� Liquid Disposal Site within R (d) Solid or q p n Two Miles t x o� ;' rw . 1k fV1 { X M Yes Yt ❑ No od Q /k1'. 11/ e Re- 1 3 22 .'i r -iot i / )1F 1 '7Z T°4rd7 s `.. A 7' '• �`, ' a : h r � ../" `. "--1- . C r 71)` A1. ! t ' 3i t a ,C ; b1 YF4, .1 . '� A ' 9 01. 1 1 44" , wxw ^ 3 : , TR � 5 y�,7 u ^' , ' w 1 ^Pr'i n .„Sr�+'�Vp'4.:. '41".t.':ill I &X 3lq! 4S � d Or 1t S "� I ; x ':;.',...4.' 1 i01 r, t n 0 0,,i,• :JV,1",- ■ ' s , 1 115113 page 1 oft t ,1 1 ATTACHMENT 3-B r 2013-206 • . . .. . .. . .— • .... - • ..... • 11. PLOT PLAN;20.e,- - aAk*acklea '''"\- - c31‘aY) te[bewail aka,sketch and label the 2.1C:;000 • (a) In pempedNe _ .■.; Assessor's Parcel No. CjIMIL},‘ N following Items:well ktt froPeThr Ones.other wells. (hnciucki abandoned weirs).sewage disposal t, systems*viers,Sepnc tanks,krachkreg gardli‘ !, X \ . seempuits.,,,mviza. ),lakes and ponds, watercourses IMO animals or fowl kept. (e) Indicate the&planes,in feet,of any of the folksshlft , s which mm061.500 ft.of the Well eke: • c;Plest3See Seer ,,,,„„•-''' ---..-- ' tatheed ...''' -- • -t -s • - . . ,, . .-4e.,, et. .,. ,............... Other.... -, Sewers • .,_ \ ... e/ t Sepfc hulks t 0 st . • •-",t,t ts / - er .. 4.0. 4 ‘ Leading fields 17 I i 1 ..tiApirtit \ . , If # SO4426011 8 • • ,:l % 1 0 , , 0 .*, , \ 1141.00V4 # l # I° , / e \ s s s I 2 a a, .4... 0 . E I I / AP I 1 t s takes and ponds _ _ _ W / I. 1 a I,t a. ' . I. , ' la,e50-' - , , I 1 . , I., I . - ' a : ' Wateroo areas _......_.- . . . f I t tt • \ ) ,v a*...." OP I • l'°''4;43*.t;t ' j '1.4terri . I F S . 4 . • t Animal or fowl kept ___ s . • s , :, i : .1 . eg N. t s t L ' r t . . • • ,T • "..... I i I ..0 ... *, ... Using an/snow.show the sairossolgo • , • • 'futon°pattern of the Property and show N. 1.,.. •• s . .• 1 ,i,....../ i amiss mad .„,,. e,to the well site'ANTI SOO . tet. •ei• ......----. 4, .$ * ' . • . ---.-- XVIC-V CZACt'-* ...s. - f . -Cif'Pin..rfait7S..,. dirgr.,*1 GYI ''''..,,, 3 0 1.--'' • • . .••••. -- r t.,i-- co 0 No of the above are within 500 feet of the t well sta. Scam if&we=100/eel . V S "Moomplere aporkettene writhe ribmiscf." . 12 I have read this application and agree to cool with FIE*4......._vis regulating the type of work being performed. Date a.- 27- 13 C-57 Contractor's Signature • , . County Registration No. I g/3 . 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HEALTH SERVICES rAtf.iiiit:4.'w' Phone:(800)442-2283 :...404:44•./. •1..,.. 4,k".1,4.LO'k:,,li&Vs','-tP1*.:^.: www.sbcountv.00videhs t %...- .•"0„.'"'"ilr'',e'll',4..,,:.,r1,14z;14!Ve tt,Ifq..ttd:-. )0;,i A!ailiti:Vvi.7.,, -4%-1:747.4r-,V7;"%..4vV°'‘.1%.e.it 1 - %.4.-t ,,, . .k'!.-,r.-, ..,::::„.,,,,,s•-,%,%.,!tu,..:,..-;;.ii, „,.., .&1•44e,'ktr4.042.t.*A.4,.... : 4, ''''''. '54'4'.''''';.-1= (Please Pria* itAtid--z.4.- `..?:.7..t,w,:e...;.1-1::. '" ' , - •. "' -- ' OWNER:Name 1 p' Items 8 through 9 to be estimated forsneeawl 5. ANNUALAR SEAL: nviDeips,thexact.ifortil other wells ft. Site Address 1'7 „...„ - 2v-3 S ikttier titan Ave. Furnished by: Owner 0 Cron • 9ZLICf3 cien0 Zip 510 sD er i ay el i nn gOm an n deur cat oi fl ID i;2).wn_ Contractor icknes City 5341 gef VICIV Seating maledal shell be placed In one continuous pour --Po Mailing Address lorig5 s-w I irdnito-Y1 flue. 6. DEPTH OF WELL(feet): Po 1.3 City e• rtx-scri • Zip q Oa iC) Proposed )4 Existing " DIAMETER OF BORE(in.): Pi CASING INSTV-vl-ED: \14:Cas . : Telephone Number . (114) "1 i— tL> 0 7. .__Iffj--40 Ing standard . 2. WELL DRILLER: A It Drilling Co. 01 Steel 0 pleseeti Standard casing 0 Other ft 1 Dia.(in.) Wall(Gage) 1 From(k) T4 6., .... 1., i I 0.;1221 zo 13 04,052201 0 -L- a 5ZaiP it _ k:L Yes D No 3. INTENDED WELL USE(check): From ac-1.3 to 41 0 • ft. 0 Agricuftural 0 Horizontal 0 Test 8. PERFORATIONS(if applicable): Screen in-ler-vat D Cathodic RMonitoring/Observatidn D Dairy 0 Residential Community/PWSiCity 00 miCitnhierlar From -1 5 o t 90 ft. 0 industrial 0 GeotherMal Pumping rate(gpm) . 4. TYPE OF WORK(check): New 0 Reconstruction 0.Destruction 9. SEALED ZONES(If applicable): From -q-t to --E. ft. SECTION MAP-DO NOT FILL IN Sorge I inch-34 mile 10. LOCATION INFORMATION (a) TOWNSHIP: ,-, ,, os . .„,.., . . Tier 1 teyange !I__ r— ection .1--.4-- . t 4$C Vht) itil 24124 60000 (b) As s arcel No. 0 NW % .1> NE % "'i Latitude and Longitude — (c, Lat. Ss4 ei' 05_ . ... 'Lorig: U1 .-4:-...Ito 1 2. TO (d) Solid or Liquid Disposal Site Within Two .Ili ruanftb ler / .,.---•"----e,ro ‘7.,,,. a Yes r1L-1 No S!Atel V\k"' t.t%Al„..n Location 2.2.2 IN-1-17D5P. - ... ) 1 . 1 . ____• Ok- . _. , „ .,,,,,,,.,-,,,„,4„,,'iy),..4,...7. ?;::;),',,,,:-.,wuririV?: ,•-',-.'',';:": :711,-'4,'",';'Vf::,:',.:'' 1 „, „,,,,,,,...„.„.„„:„,,,,.,,,.:;r:W4,74-4...;U:TOT,'";;g:,"11n1 r 4'11;1 SW Y4 SE % ClIt-iTlilagfigi4V4Vgi-OiTi:21;i4.05.$111I7V,Nt":41.114%. , v lAr-f'..9 V'..r: ,.' 'N=41,-.-„'.„t°.k.,',4`"=",',;-.":"-3ftaikkIT-744",,'•VIRP^", :k11 A 0,-;.,ot,':,..4t04; ,;_itaziati,. ;.t. 'i4;T.,,,rgme-v:r'9rY-cttRtr, ,,,..-At:,,,,r,A, r2.54::1!;,,, al' ...'),•-ti,xe..,,,,Q 0;11.747.,,AnWitV:ter:4"firr;:r. ,:il'.■ ' 11 iithe4 ety, olorK , .-,...vo,!-9•1,,:1/6.4;,:;*„.,rlolAti,• „:,,,:,:. (1,44,,.:otai.;.,;.,!,t: ■, ... ' ,-----------T--, -! ...-••■•■•■• 1115113 Page 1 of 2 I • t - . . . , . t ATTACHMENT 3-C ) 2013-206 11. PLOT PLAN; T (a) kl peaspedt e to the well sires,sketch and tab&the Assessor's ParcaiNo. ql4!�I 2(�oaOd tomiterrfa;+ lodtpropertyrube,other wills :. I s di systems(sexr9ns,sepfictanlfs leachingfteW 1�3--2 seepegs.p)es ce oafs),takes and ponds. �, wetemouro s and:wheals or keel kept. ro) ysNcatq,hs distance,in+feat,of sny of the following /.r {uhicb areTritttdn 600lt-ofthex{e41 as f f `� attachgzc -'soot- -"--#.--- ,`\ Other f � ecwers " f/ %,,s \ it p ---. - I , `� �� sir \\ $aptic arks rt fl / I f'�—.rrw�\\ \\{, t J �{ Seepage ptta l r f // II �� 7~0 Cesspools r, + f 3 ` { �i `� C W ' s i • { { .,Lakes and ponds { \ ., / { f .l f ■ J .t - \A ! 1 ± ..{AraUescotases i ;' `r- _•-� ff / f Animator kiwi kept • %l \\ I f 7 .. r \ [ I J \ A f I r b \ ,. t . J ,- . Ia_ y Using en arrow, the appro ximate `�\ s / i. . &Mono patron of the propertvand show \,A `A\` . �` �I// roads to the 500 (e) \FID None ofthe shove are wlddn 500 feat oldie we%stle. Sratac:Climb..?OO fee! S "bwomplets oppliestrons win be returned" 12. !have read this application and vree to ?*with all laws s no the�of woric being performed. 7 C-57 Contractors signature f �y Date j�t7` 1 - County Registration No. t.+ California License No. 7`t_OXS OFFICE USE ONLY DO NOT TE BELOW THIS LINE r r7 t '� t r -1 9 V iE jFT r $ f >q{ f}3r' t 1 t(1 r-: T —�F p rt a 1 ;4 , 11 4 11 } 1 ; 1 r I r' t t:1 tf 4}t [� V 1 1 1 �{'� 2 1 ' I y �k pl':"lr. V8 f d 1 ii"y t'E P r 4 jl ,,l 1 ,t .i.' , 4 I I firGr y 3 t r 1 , r :,v,....,2::::,:,,....-.:;:34•y',1';6 lif r, ', ' r I !t 1 Yl,i r �� i r t'r � l ti i t � ,��i � �ti� z i g x�, 3 i �r 1 7 v i ▪ I, � l i� ' r t; 1 ,�} r u I t 1 r t ,, l 1'Y r , r li f Y II 5 F tl xy ' {i rtat i r,lt� Ir }, Yet t� 7+ t .i a Y � y i ( I i } h' s fi i �a r . 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',.: .. y{i,M { v ks+.l .,, r-xry� "�-'r�x�r r 3.ti �-��. .S i �,q" i t- t{1 H}b> 1)'Sl ii, "{ IT5 'r'=�i f7 ,1'yS��l'_.i� iL - �, S ( Yt' .' d�� tr x '�''- i 'J y� �A .,i. d'e r a..- 1 t}'+" ,W, - Lxr n'3u,.S#. 1 .mss a'i'.•a e i `1''„ ,y ,. r�, Ll'�ASfw...�f �.�:.�wr,a e �' [�ym� ,'a+Ti r.i Le Y f€rct 't'� .i �j ytr q .s+ o- p R' Tc. : 24 7' s F,.i:•x � 'pia ` : C '•..::t,I s�®i� i3.w.M.f�..°`�S's±.., ei...s.-n.: ,�'�� >'x ��" '1�.;�h�.!a'�t::ci�G,�''� ml. a.fik�a �m � !Y!_4. yttt. �.� Page 2ofZ r . . t 2013-206 LICENSE AND AGREEMENT THIS LICENSE AND AGREEMENT is made and entered into this 1 5th day of .T y , 2013, ("Effective Date") by and between EQUILON ENTERPRISES LLC dba SHELL OIL PRODUCTS US, hereinafter referred to as "Licensee," and the CITY OF SAN BERNARDINO, a municipal corporation hereafter referred to as "City." WITNESSETH: For and in consideration of the mutual promises and covenants herein contained,the parties hereto do hereby agree as follows: 1. City hereby gives permission, removable and terminable as hereinafter provided, to Licensee for encroachment of three (3) groundwater monitoring wells and appurtenances thereto ("Wells") to be located in, under, along and across Business Center Drive, north of Hospitality Lane, a public street in the City of San Bernardino, as shown on the plat attached hereto as Attachment 1 of Exhibit "1" ("Encroachment Area") and incorporated herein by reference in accordance with that letter dated April 9, 2013, from Conestoga-Rovers & Associates, a consultant for and on behalf of Licensee, as set forth in said Exhibit "1", and subject to any requirements or conditions as may be imposed by the Director of Public Works of the City, or his/her designee. 2. Use of said Encroachment Area shall be for the right to construct, maintain, inspect, operate, protect, repair, replace and retain in place the Wells as indicated schematically on Attachment 2 of said Exhibit "1". Licensee agrees to install, use and maintain said Encroachment Areas required by this Agreement. All Wells installed, located or maintained pursuant to this Agreement shall be so placed and maintained as not to interfere 1 of 8 2013-206 with the use of any public street, highway, alley or bridge by the traveling public to any greater extent than is reasonably necessary, and the placement of any Wells shall be subject to approval of the Director of Public Works so as not to interfere or conflict with any existing or future storm drain, sewer, water line and any other utility or improvement owned by the City. In installing, replacing, repairing or maintaining said Wells, the Licensee shall fill all trenches and leave the surface of said streets, highways or alleys in as good condition as it was prior to excavating for said installation, replacement, repair or maintenance to the satisfaction of City, and shall comply with any and all Federal, State and local laws, rules and regulations applicable thereto, including the requirement for obtaining street cutting permits. Street cuts, temporary encroachment permits and restoration of street cuts shall be completed pursuant to City Standard 310 and subject to the requirements as set forth in Chapter 12.03 of the City of San Bernardino Municipal Code. 3. Licensee has obtained Well Permits from the County of San Bernardino, Department of Public Health, Environmental Health Services, a copy of which is shown in Attachments 3-A, 3-B and 3-C of said Exhibit "1", for the purpose of installing said Wells. Licensee shall keep said permit in full force and effect during installation of said Wells. 4. The Encroachment Area shall be maintained at all times in a safe, neat, and good physical condition. City shall be the sole judge of the quality of maintenance, and upon written notice by City, through its Director of Public Works, stating in general terms how and in what manner the maintenance is required, Licensee shall be required to perform such maintenance. If Licensee fails to do so, then City shall have the right to perform this maintenance, the cost of which shall be borne by Licensee. Licensee shall, at its own responsibility and expense, obtain and keep in effect all licenses, bonds, insurance and permits necessary for the installation and existence of said Wells and Encroachment Area. 2 of 8 2013-206 5. City reserves the right to improve, widen, vacate or relocate any highway, street, alley or other public place, or portion thereof, over and within which this License and Agreement is granted, including the widening, change of grade, construction or reconstruction of such highway, street, alley or other public place or portion thereof, for the purpose of any public improvement. If notice is given by City to Licensee that work is to be done pursuant to the rights reserved herein, which notice shall specify the general nature of the work in the area in which the same is to be performed, Licensee shall at its expense, do all things reasonably necessary to protect, disconnect, relocate or remove its property during the progress of such work at the required time in order to accommodate such work. All such things to be done and work to be performed by Licensee shall be at the sole cost and expense of the Licensee. In the event that City shall hereafter construct, install, reconstruct or repair any bridge or artificial support in, on, over or underlying any highway, street, alley or other public place or improvement in which the Licensee's property is located pursuant to this Agreement, and in the event that the cost of such work by City as may reasonably be required is increased in order to provide for the installation, maintenance or operation of Licensee's property in, on, over or under the area covered by such project,then Licensee shall pay to City the full amount of such increase in cost, upon completion of such construction, installation or repair. Any damage done directly or indirectly to any public street, highway, alley or other public place or improvement by the Licensee, in exercising directly or indirectly any right, power or privilege under this Agreement, or in performing any duty under or pursuant to the provisions of this Agreement, shall be promptly repaired by Licensee at its sole cost and expense, to the reasonable satisfaction of City. 6. Licensee hereby acknowledges the title or paramount interest of City to the public right-of-way and agrees never to assail or resist said title or interest and to observe 3 of 8 2013-206 present or future set-back requirements relating thereto while this Agreement is in force and effect. 7. Licensee shall, as and for the consideration for the granting of this License, pay to the City of San Bernardino, forthwith, the sum of$625.00 due immediately upon approval of this Agreement by the City. This Agreement shall not take effect until such payment has been made by the Licensee to the City. Licensee shall also make an annual payment of $150.00 to the City which shall be due and payable on January 1 of each year while this Agreement is in effect. 8. City reserves the right to terminate this License Agreement at any time for any reason by giving Licensee at least thirty (30) days written notice of such termination, except that City may, at its election, terminate said permission forthwith at any time if Licensee shall fail to comply with or abide by each and every provision herein or keep each and every one of Licensee's promises herein. Waiver by City of any breach of any term or provision hereof shall not be deemed a waiver of any subsequent breach of the same or any other term or provision herein. If not otherwise terminated, this Agreement shall be for a term of five (5) years commencing on the Effective Date of this Agreement and ending five (5) years from that date. 9. This Agreement may be extended for any additional terms upon the recommendation of the Director of Public Works and by written mutual consent and approval by the Licensee and the City Manager. 10. Upon termination of this Agreement, Licensee agrees to immediately remove said Wells from the public right-of-way and to restore the public right-of-way to the satisfaction of the Director of Public Works. If Licensee fails to exercise its duties under this paragraph, City shall have the right to remove said Wells and Encroachment Area and to 4 of 8 2013-206 restore the premises at no cost or liability to the City. Licensee covenants and agrees to reimburse City for such cost of removal and/or restoration. 11. City shall in no way be responsible for loss of or damage to said Wells or for any property belonging to or leased by Licensee, its officers, servants, agents or employees, that may be stolen, destroyed or in any way damaged during the installation, use or maintenance of said Wells and Encroachment Area. 12. Licensee shall exercise its privileges under this Agreement at its own risk. Licensee shall indemnify, defend and hold harmless City, its elective and appointive boards, commissions, officers, agents and employees from any costs, claims, damages, injuries, and liability resulting from, arising out of, or in any way connected with, the City's approval of this Agreement, the construction, installation, use or maintenance of said Wells and Encroachment Area, the occupation or use of the public areas of such structure, both during and after the installation thereof, and including but not limited to any costs, claims, damages, injuries, and liability arising from the acts or omissions of Licensee or the employees, invitees, guests or agents of Licensee in the performance of any work authorized herein. 13. While not restricting or limiting the foregoing, during the term of this Agreement, Licensee shall maintain in effect policies of comprehensive public, general and automobile liability insurance, in the amount of $1,000,000.00 combined single limit, and statutory worker's compensation coverage, and shall file copies of said policies with the City's Director of Public Works prior to undertaking any work under this Agreement. City shall be set forth as an additional named insured in each policy of insurance provided hereunder. The Certificate of Insurance furnished to the City shall require the insurer to notify City of any change or termination in the policy. 5 of 8 2013-206 14. This Agreement is personal to Licensee. It is non-assignable, except with prior written consent of the City. Any attempt to assign this Agreement without consent will terminate the privileges granted to Licensee under this Agreement. The City will not unreasonably withhold consent. 15. This Agreement shall be governed by and construed and interpreted in accordance with the laws of the State of California without regard to principles of conflicts of law. The parties hereto further agree that all actions or proceedings arising in connection with this Agreement shall be tried and litigated in the courts located in the County of San Bernardino, California. The aforementioned choice of venue is intended by the parties to be mandatory and not permissive in nature. 16. In the performance of this Agreement and in the hiring and recruitment of employees, Licensee shall not engage in, nor permit its officers, employees or agents to engage in, discrimination in employment of persons because of their race, religion, color, national origin, ancestry, age, mental or physical disability, medical condition, marital status, sexual gender or sexual orientation, or any other status protected by law, except as permitted pursuant to Section 12940 of the California Government Code. 17. In the event that litigation is brought by any party in connection with this Agreement, the prevailing party shall be entitled to recover from the opposing party all costs and expenses, including reasonable attorneys' fees, incurred by the prevailing party in the exercise of any of its rights or remedies hereunder or the enforcement of any of the terms, conditions, or provisions hereof. The costs, salary and expenses of the City Attorney and members of his office in enforcing this Agreement on behalf of the City shall be considered as "attorneys' fees" for the purposes of this Agreement. 6 of 8 2013-206 18. All official notices relative to this Agreement shall be in writing and addressed to the following representatives of Licensee and City: Licensee: CITY OF SAN BERNARDINO EQUILON ENTERPRISES LLC dba Department of Public Works SHELL OIL PRODUCTS US Real Property Section 20945 South Wilmington Avenue 300 N. "D" Street, 3rd Floor Carson, CA 90810 San Bernardino, CA 92418 Shell Program Manager: Andrea Wing Ph: (909) 384-5140 Ph: (714) 731-1050 Fax: (909) 384-5190 Fax: (714) 731-1038 19. This Agreement may be amended only in a writing signed by the parties in interest at the time of the amendment. No amendment shall be binding upon City unless formally approved by a vote of the Mayor and Common Council of the City. 20. This Agreement constitutes the entire Agreement between the parties with respect to any matter referred to in this Agreement, and supersedes any and all other writings and oral negotiations with respect to any matter referred to in this Agreement. The terms of this Agreement shall prevail over any inconsistent provision in any other document relating to this Agreement, including exhibits to this Agreement. /// /// Signatures to follow on next page 7 of 8 2013-206 LICENSE AGREEMENT FOR ENCROACHMENT OF THREE (3) MONITORING WELLS WITHIN BUSINESS CENTER DRIVE, NORTH OF HOSPITALITY LANE; IN THE CITY OF SAN BERNARDINO,CA. IN WITNESS, the parties have executed this Agreement on date first written above. CITY OF SAN BERNARDINO: EQUILON ENTERPRISES LLC dba SHELL OIL PRODUCTS US: AL J. PARKER, City Manager Print Name/Title:3',/. ( Z & 4�11r I/M/t4C1 V t=a rp- 2/o, Approved as to form: JAMES F. PENMAN, City Attorney By: L' -� 8 of 8 2013-206 M 175 Technology,Suite 150, Irvine,California 92618 A Telephone: (949)648-5200 Fax: (949)648-5299 www.CRAworld.com CONiESTOGA ROVERS &ASSOCIATES April 9,2013 Reference No.060675 City of San Bernardino Public Works Department-Real Property Section Attn:Ryan Sandoval 300 North D Street-3th Floor San Bernardino,CA 92418 Dear City of San Bernardino Public Works Department-Real Property Section: Re: Encroachment/License Agreement Request for Monitoring Well Installation Shell-branded Service Station 1930 South Waterman Avenue San Bernardino,California RWQCB-SA Case No.2002025 Conestoga-Rovers&Associates,Inc.(CRA),on behalf of Equilon Enterprises LLC dba Shell Oil Products US(Shell),requests an encroachment/license agreement to install three groundwater monitoring wells on Business Center Drive in the City of San Bernardino (City) right-of-way. The wells are being installed to gauge and monitoring groundwater for California Regional Water Quality Control Board-Santa Ana Region(RWQCB-SA)Case No.2002025 at 1930 South Waterman Avenue,San Bernardino,California. The wells will need to remain in place as long as the RWQCB-SA case is open. This letter is being sent in response to the email received by the City on February 26,2013,a copy of which is attached hereto. The City requested that we obtain approval from the City's Water Department for the wells;this approval email is also attached. The City is already in receipt of the permit application,which was submitted to Darren Hall via email on February 21,2013. As requested,CRA has also attached the following: 1. a CRA Site Plan showing the well locations, 2. a well surface diagram, 3. a copy of the County of San Bernardino well permits,which contain additional well construction details, 4. Certificates of Insurance,and 5. a check for fees ($683.50). A'H.+c IBi Equal LI i� Il 1�� Employment Opportunity ! Employer F � � Worldwide Engineering,Environmental,Construction,and IT Services 2013-206 CRA CONESTOGA-ROVERS &ASSOCIATES April 9,2013 Reference No.060675 -2- CRA is the environmental consultant for the well owner,Shell. Please make the Encroachment/License Agreement in Shell's name. Shell's information is provided below: Equilon Enterprises LLC dba Shell Oil Products US 20945 South Wilmington Avenue Carson,CA 90810 Shell Program Manager:Andrea Wing Phone: (714) 731-1050 Fax: (714)731-1038 CRA appreciates the opportunity to work with you on this project. If you have any questions, please contact CRA Project Manager,Angela Ribeiro,at 949-648-5211. Respectfully Submitted, CONESTOGA-ROVERS&ASSOCIATES Angela Ribeiro DC/cg/1 End. City Real Property Section Email Requesting this Letter (dated 2/26/2013) City Water Dept. Email Approving Wells (dated 2/26/2013) Site Plan Well Surface Diagram County of San Bernardino Well Permits Certificates of Insurance $683.50 Check for Fees cc: Andrea Wing,Shell Oil Products US(Livelink) !. 1 1yX1y X+ X x 1 Worldwide Engineering,Environmental,Construction,and IT Services - 2013-206 . - . 0 30 60ft 12Eiiii LIL \cl cpT.23 cBoURRNp. c.11 a CPT-22 CPT-17 S8.3( 17) 0 cprr.18 0 CPT-19 OCIWORT INN MOTEL ......0-• \\\pooL -7 -Z- .,. V. OA 1%'■ 0 "P. -5- il N Imw4o Ot< N. WELLS TO BE INSTALLED ..\\ IN CITY RIGHT-OF-WAY ci CPT.24 El CPT,21 COMPORT SB-2 INN Elb MW-14 MOTEL 1 CPT-25 .MW-12 0 CFT-20 • 0 CPT-16 0 CPT-14 0 CPT-13 0 CPT-12 Z. 0 2 17- .2 — 1 BEST , - z INTERN MW-211 0 MOTEL - 5 M •mw. * '3 1171111111.11111111111111111.1111.1111.111111 1 1 IlD CeT*P 431 I id . PARKIN11G CRT-10 • El CPT-15 k PT-S 0 AREA MW-16 - ].. '1L 1:1 MW-10 II ,1 -- rirl it,64i dF'r•741 — PT4—ircs4 1 1 • ". q 1 ..i 4 IS 7. I. _... ......, , _...„ „.., CPT.20 ..1104 I a MVV1 MW-22 o _ MW-4•0 104 1040-4 " .1 0 0 10.1 LCI.1 0 PZ.2 •hirwial kl BEST 1°-.1 !_... 3 '' •MII,A7 4 MW4 STERN Orr-2 ..,..1.1 ig 6 • mom I DISPENSER ....,,,,,,, r'11.4 15 OSK i [2; ( „ , --- Ili ill I .•AA* D=SI I i POOL I CB.3• ii,, 1.4191r-•MVV1 I *aikil,:e I AREA MW-2• / , 11 s I 2 1', PLANTER MEMO, I 'H-3 . iPLANTIDEwfV*13 i je.. HOSP/TAUTY LANE — — II ''''----------- -,, ( SIDEWALK ( SIDEWALK ......., LEGEND MW-1• MONITORING WELL LOCATION Pll 19 PIEZOMETER WELL LOCATION 10-1 e 02 INJECTION WELL LOCATION CB-1• SOIL BORING LOCATION PROPOSED WELL LOCATION MAP CPT-1 W CPT SOIL BORING LOCATION SHELL-BRANDED SERVICE STATION 0I 1.1 if FORMER GROUNDWATER MONITORING WELL LOCATION 1930 SOUTH WATERMAN AVENUE ! (21-9 C) PROPOSED MONITORING WELL LOCATION San Bernardino, California 60137545(011)0N-WMA2 FEB 412013 . . 1 ATTACHMENT 1 1 . ,,, .. __ 2013-206 APPLICATION FOR WELL PERMIT $r•, 6.A. 7 ° tfi 4 k w - jf4 1}-15,,:r i *v County of San Bernardino x` i. ': a r , '0 4 z1 +i e.. 4i, E` «'` om '{ , t ;1 h . .✓< E �;;�E s i�a rSMk Department of Publc ea � ,� � !� r , „ �'� 't. ;, j 3 DIVISION OF ENVIRONMENTAL %'' . "F lV ie 1=' r. �y X .o " �" t" HEALTH SERVICES _ dt� % Cri.� -"' It4''. t 'r 3 t "r ;{�� y,, "i`'}:ary' " a. . :a: u{" � �3 t,; 2 t t t F '.a r N,"x " t a z ar, x " ` `° „ wwwbcount sovldehs , ,y+Y ova''j4iti,,' .tt,4 „*:i t 4 tr'i 1 1l 4 0f . r l z4'i2 - ti`' x+1:. c', ;" T.'0+� I" (Please prlA) µtr-21) 61* �,t�3 : 1 a „ i ! 1. OWNER:Name TJV1e),,t O j l Vlt 1$- Items 6 through 9 to be estimated for wets,exact for al!other Wells 5. ANNUALAR SEAL: Seal Depth -i1 ft. Site Address 1930 S.kMa er Man Ave. `'' Furnished by: ❑ Owner 10 Contractor 0 Driven Conductor Dia. in.,Wall(Gage) City +ge.>nslarclin)Zip 92..-f 0? igi Sealing Material ?ra±„_aratIEThickness in. t1...., Seating material shall be placed In one continuous pour.__ Mailing Address 'Z.tYlt-i• 7 '- 1�,t't1i'tnl E n t'tvE• g, DEPTH OF WELL(feet):. 'to -•c4a City Cciurson. Zip e/..08 re) .-, , Proposed X Existing DIAMETER OF BORE(in.): 8 Telephone Number ('111 ``l s 1— 1050 - `•" 7, CASING INST4 EGD: asii g standard . ` c'� - 7 ❑Steel P slit ❑Standard casing ❑Other 2. WELL DRILLER: ` tt pv�w= , To(ft.) Dia (in.) Wall(Gage) i � From(ft.} 0I05 20t3 0 12015 4 C' e o . Z Del@ C Pads:]�,Yes ❑ NO r 3. ' INTENDED.WELL USE(check): Frpn} -�3 to � .`° ❑Agricultural ❑Horizontal ❑Test f ❑Cathodic' 'Monitoring/Observation Dairy 8. PERFORATIONS(if applicable): Screen trr 2 'vat • ❑ Residential Community/PWS/City -Other ❑Industrial ❑Geothermal 0 Mining . , From -15 to Pumping rate(gpm) 4. TYPE OF WORK(check): 9. SEALED ZONES . tia New El Reconstruction ❑ Destruction From - . {'hi SECTION MAP—pet nor FILL IN Scale t!rich-Y.mile O. LOCATION LOCATION INFORMATION, r - I (a) TOWNSHIP: Tier , I N ange r E ection 2•-2' (b) Assesss s Parcel No, QA't-t 1 t-t t Et D NW A e NE (o) Latitude and Longitude 1 Let: 34 °r b ', 512/2n es Long: )tEL °, L( ', 145,1 `EJ (d) Solid or Liquid Disposal Site within Two Miles roar I Yes ❑ No `�oliCi VC� MPary14= M )?It r Locatio 222 1N. +‘- t 1X'1�1�" ! ___, i t.? r.a ' yx 4.* f`'r ar O tI R�t'S 6L�,~J r?t 1. + *y,1/ lA ri} 32,ig S, v tix µt F,erg: 5 II Lvr,&!,. c ''.'''g # ,.. /�DSPerils.,J*� ;j L a ? =4'' '"a+�*r:. y "p rR, n'- f,---v-•fi 4, SW Ys SE t/s ..4.1Mv} '41,1446,!; y_ xr ` kr,x ' t'w- "ii,4y`," '3. f q y 3}v '�3t d d 4 Jr t �. �" 1 i.0x " Safa1X iqM� .. �{;4r 3 L: rw 44 t t a . �.3 4s ?'" Ettl " ,z`v c gym,'.'' ` • . F .,sr'' "..",:E-,ii::'.:::,.... Page 1 of 2 1115/13 I 1 ATTACHMENT 3-A 1 2013-206 , 1i. PLOTPLANp � � Assessor's Parcel No. c)\l41412-f! OOOO (a) Tn to sketch N f0naw+ina item.:weg lot propedtr l issx ottservuela {unauEe ehendo led twat seenspt&swat s y s t e m s(r o w e r s.aeppdohmks,teschlopll and ponds. �, 1 --Z° watercourses a�ls or fowl kept ,"4 --., 5e6 Y`' - --- (6) vhlclitdw teare ih ewtdat ne dn 50o.n of fe the t.of web an yffe ofihefoowtnO �. other w. !� Spctenks, ! ____ .4-_ _�` Leaching lekls r r 1 r `•.\ +' / 1 ! If \`I 4 { 1 cpoctS 1 1 1 r , 1 1 1 E IN i UVa i 1 0 Lakes and ponds , 1 i sub i r , Watercourses `I t, 4 _. .�E ' ,(', I R Mtmelor fowl kept 1 r '+ `� - "`• Using an arto11,show the spprwdmata `• rr. r*" / drainage pattern altos PmpertY and Shaw t. * `,� f!' amass r-oa�d{s to the a+ett site within 600 a feet t (o)ykr..at the above ere within 600 feet of the Seals:3f bxYi',100 S "hrtpmplIte evellex!rores will be neurrred." 12 1 have read this application and agree to ccrnp wig". ,Regulating the type of wont being Performesd. C-57 Contractors signature , F—�~ Date �ty�.{�' 3 County Registratlon No. I A Carrfafiia License No. 0 O ' OFFICE USE ONLY DO NOT WRITE BELOW THIS UNEgqrT f rr r 1 t F , r tM , ; , P� [ ,1 w .[ [ ?;mom' J.' 't+ 1 i l A4 :' . . t,,,I a ��r 71 �� 'a ,.t fl f :�� 1 i I . F X41 Jk 1 °r ., 1 ,4; '�i i 1 I �'a C'fi�^.tqa 1 1#�. i 4 1 $: pp 1 tit !_i P r i f ,�{ F1 ;L f i .t. 1 F t1 F 1; j [ is 4 iF f', lj'J i1 °' al n E ;: ';',i0 M r r �� .,� i� E� J � i , l4Y 1 T. 'ft, +, i Y d' t4 1/k rr 4a ''•C r� 1;i ! L II F id,1-;:',.; ,[ r; I! I1 1, F ` l is �4 G � ..X *• a tl - 4 lz It I 1 [ 1:,:.,,,.,,,,.:,..,--..,,;,...:...,, ,,f' v .S I'4it,..,:'k.!.,.'..%.,;-!'!;!!'.?:'-r t�p 1 i')+. F J1,:. ' a ,gin �:1 Y i f r ( 1 1 ;; CT`,, �.. ` �•� [ i I1 ''" : C 19 t' 1� • ▪ r� sti}4, S : :t4 .'t G1 Yi[ I'' `. IfR;t . ' }4s ; � ' ALT tV' Ok ,•[ 5 . ti . t� [i !iii [ t ?.ts) ?[Y F 1",, 1 Y!p�:1 i 7 ; .F, li _ j � V:CI' : ) s ' , ;-. x� I s . 1 r11 iti lfr [ t T{i .. ti �� 11• e y 4 1Itr t}'1 1 I zs[ .1 i, 11 ti l- 4h � ,i S t`1c.f1 1 < n , „ � [1 r. 1 1 a l[�0w. �d )t�' r { a 1 l ,, ,':'1' ,t i d t ? ;' r :1 t G2`� 11i1 t [ 1 fi 4t rqi.:? �r � P 1 t � ha 'l a i �1 ( r y1t1 t��S,, i� I u It !, l la l! [ 1r � l.=� 1 , � [ i j la, i. [ [) ' t + ii'f il ;'r �' ,. vt , , ; t‘;:i i i'.ix x l li -Jr , u{ ° tf i l!Ir L' ? fi0),ff 4 k:•17 e , :=, 1 ; py 1 it t ' - r^ � ▪ f,f ' ry(' l ' k,,,r,i, I 1 v�t[i ,tq�"q• 'il f Oil .. �1c}r l,.a?�,,' J ' ay lg 44 D' ti d { ' s 'k si r r ` Y ar hrir- ,��j-i i110: : & ( "-r � ,, s 1 1,tk 1 a, ,. .1 r d 1 , 1 iKY y f ix r L c E: A ,l} y .,1 .: : fr". 1 ri 1''' "{'-C Ii ' 'S r 1"' I T'S1 l ear t« sry'1�§;le).- E 15 c.3 4 4ti,.T 3 fl n.,,,, C r S C 4"Cr ug ✓n 1 � t .; .• [g� 3i<F N-:*i Ki't tF r = al,r [5 r` b 11 '?,;:f.I tiS 'd tt v ;} flv y° i� l -0 rjf Lj,Y' ,t s � f„ il t k c+ti''Jq[>T V. fAid': •,I n,I ,I ",',5 }:` k�L t?t sltr t�3 Ge�u.aw ,F tT 1 f r rn. l,1 t ','r ..,-,i,l:.'T' r'`P'.1it sh atitu1ri k\IL � 1.i.g..0,•,s`7!:, ',;'x i+' r 4',,};q Sli. "5 ° x ?Fr c `lr'Kr S �, [ 'x "`.f� ' t,, i'll^ L 4 ,°1;T }', h ; r VI' i 4.f '1kAtts> 917 ,. .nit tk4i . , 3.5.1, ,sr .a .r:,n1 � s i ' i rN 3 ( � "` w ',4 ' ak ' a t 3i3 s , .J .s. . 9 i • ,�� zet 1,1513 ... Paget oft , _ 1 2013-206 FLUSH-GRADE TRAFFIC RATED WELL BOX 12" CONCRETE PAD 12 —'I 1.5'TO 2'DIAMETER METER ??t~s: r ,Y F it OR SQUARE i 4�� ,� � t� ./'�'"�"" CONCRETE .. '.c ' � 0- 1 FBG 2"DIAMETER SCHEDULE 40 BENTONITE GROUT PVC CASING Imo--8"—►1 NOTES: FBG=FEET BELOW GROUND NOT TO SCALE. MONITORING WELL SURFACE DIAGRAM PROPOSED WELLS ON BUSINESS CENTER DR Shell-branded Service Station 1930 South Waterman Avenue €RSA San Bernardino, CA LAST UPDATED BY DCOBB 2/20/2013. ATTACHMENT 2 2013-206 . • • • . . , . , OPOil . APPLICATION FOR WELL PERMIT .s,,r... .--45-3447 County of San Bernardino 10 nrAffn- '''' 'il'fil.4* ',-"‘24' .0 -;l?4,‘'--,e Ag• -n of Public Health =4P10 ...,4's'AZ":.;-- . -, ' -, • '. '',!'-.7, , .'!.),ilipi..7q5.4,,gA..--*nc./"1.•54,m.,---4-Ap -y•iv..., ,4':ti•: DIVISION OF ENVIRONMENTAL , -r' • i4- 111.,---•."-f--',nRjr,c.-4-fz,,:4,-7-,,., ..`•',‘-:•,':0,, ,,,,,,,,,,,,4445-—.2s„"tv-c.,.... .eNV,-i:-.7'--;;;(17,,,e°1''■ HEALTH SERVICES .::).)4,4,00,..r1g.....7,,,,, .,;; ,4:1;$,..0.M.q. 'tog- . ,4,0.4, ‘.. ok 404A.Nti:AcEive,..?.,:lit,t...R:47R)SIA11.1`-,i Phone:(800)442-2283 •tiq't,*14t ii1/4-,- '• •,.- ••„ ',4",g,1:-- 14-4'.4..•.- ;-,M.thlitt--1.40.,,,, -tm;•tir.::.,,z 1 .',„"-:::,,.!: •,.......t•-•%,-,,-0,01 .,,;-.4-Vi www.abcounty.ciovidehs ":ti-F,-.-14-ri-Li"..' "---- ,---~'..;, '. . . .7,. ,,-,.•:,,:* i 14 (Please Pd" NU.0,--il *M.m.U. N:,.74.:,;::?._ --:...- ..-•::::'-....,'";n:':'''':-'4' 1. OWNER:Name (.51Clelarigalt...... Items 6 through 9 to be estimated for new wells,exact for all other wells 5. ANNUALAR SEAL: 'Seal Depth . —IX ft. Site Address 101-50 S. lAtt+eXITICLirl ete. Furnished by: 0 Owner V Contractor 0 Driven Conductor Dia. in.,Wall(Gage) City 'Sart eerrardiVIC). Zip qzttoo isi Sealing Material gertk--atitkiThickness in. _ .._ Sealing material shalt be placed In one continuous pour. Mailing Address 2-ccilf6 S.tulfrn tivr..- _ to -'161-611 . DEPTH OF WELL(feet): CI()-C1113 City Car96T1 Zip goeto Proposed „X Existing DIAMETER OF BORE(in.): gi't Telephone Number (1 lei) 731- 105D • .........., 7, CASING I NSTkiyAD: Watling standard ,i)&1,k' 2. WELL DRILLER: u.-4 44 a(,,iii6 (0. 0 Steel IS)taiisre fl standard casing 0 Other 03/0M From(ft) To g(o t) Die.(in.)In.) Wall(Gage) Stalt W SaVArel Pack:VI Yes 0 No 3. INTENDED WELL USE(check): From 1?) to IC) ft. 0 Agricultural 0 Horizontal 1:1 Test 0 Cathodic N.1 Monitoring/Observation D Dairy irriervat 8. PERFORATIONS(if applicable): SCreen • 0 Residential 0 Community/PVVS/City 0 Other 0 Industrial E3 Goothenal 0 Mining From '1 5 to c't 0 ft. Pumping rate(gpm) 4. TYPE OF WORK(check): 9. SEALED ZONES(if applicable): st...N.QW, , Q.Fteconstruction. 1:1 Destruction From 1 to ....... ... ft. — SECTION AP-DO NOT.FILL iN &We f Inch-r:lea . 10. LOCATION INFORMATION (a) TOWNSHIP: Tier I NgRange Lt Et9Section (b) AsseatotiCal. 01441417-150°C)C) ______ NVV % Jep NE % (c) Latitude and Longitude . Lai: 044 °, 03 Lon4:. 1 t-1 '; •Tip- •', -1#5-12.. ne0 ...,-- r- 1* (d) Solid or Liquid Disposal Site within Two Miles U4 Yes 0 No 5zAid V■Icak• t-AararY11-. rs, pie- 0 Location 2-22- vkLi-bspikdriii 1n. 1 ...—NA •_ ,,Tk f;:L:di2HV4: .....'57. ,4";P•1-,, ,:f,," ..,......,•0°.'°°°.** '''' ''', .-:.4.4j.',',4;7;7'.. : .4,, ,,...:-..,:-';',=:"-in",A4!;:it.-44-.P.ki"V,,Z ....... ........e y LA ',',. .•' `'."' ''' -41, ' ',r6 1=il,"': "..4'1".,i Hosfemzwric .. A .,.-,47":,.., SW, % SE % ;..,3i-r:;4.:Avito,w,„,4,,„,, ,,,),ilQ.: L';, ,,,Lara,:.,. QIIi:fhoirx:"L" :. :iia,VTAWQ,g,TeR,'74.84:C5,-?. .31.4 ,1,,,e,l-i,"4. ,...'''''''',;fr.',"•:-'1:1,r,"?..` '1.-.1.4,1:2,,V:`,,=i,-,'-'7,47,-,5-4--:".,,.,-c-A.4.;. 1-t,,, -4,-.' :,' - ',0.--•,-;--.,p1t-ti,;,,,-,.7t-, ,, -4,05--.7;-;,,,-t;ti-x,a7-1:.,cf,,,14,,,lit,"•:,,■! *1444:-!640101*CW::"*.M.;;STOrktitail-::::ii: :'I 01.5W;:;' , 1f•Vi !' J Page 1 of 2 i . 1/15113 •ft 1 ATTACHMENT 3-B 1 . , 2013-206 . . . • • ' ' " • • •• - .— • ... • • • akketdnea 11. PLOT PLAN: _,,-le.• and_ bet the A3111211061 Parcel No. 0101(4 i 2.150CXXD . (a) In perspective to Ihe well sae,sketch and le following Items:well tot Overly Mies.tiller mielt 14 (Include abandoned weirs),sewage disposal systems(3•Wersa SePrelankia kadiftigfield4 seepagOrs,cossliocis.and. .. ).lakes and ponds. A\ WaiNC01111155 and animals or fowl kept • a . (b) tradierde ihe itahru:e,in*et of any of the following cflee„ se.e., ---.-- „ whkh ass withal 500 S.of the wallah*: Other • ,,, . --/.."------' — , a 4...„..........„ -- ,....' s. . . a I as,,, ... , .... Sepik tanks a . . ...'" ,,, ...-.....,.. 1 • .. --...a . - . ., 1 a Leading flelda . • ,..' I ., a , 1 a I . i 444+4. '%1 Seep ngs * 1 ; 1 la`i4111.1 i r t Cesspools a I I a . $ a a • I . a la a a E Lzkes and panda a . - WI , , 1* i l' a I a ; s,.. , a ! 1 • , 1 a ., ' i• : (;,e444...t . .. .%den:6=es . ' • 1 l'a ‘1, s%'1.--a..-''' r.$4•41,0AV UJe-Oltrn Animator fowl kept , t i 1 . . rr . Is 1 I, •%, . ‘..... 1 ■. '.. Using on dillAY.show the approadmide ... a.., '''.--------- t .-' .1 drainage pattern of the property and show • a.„ a oe r . . acams maths to the well ate wallah 500 ...„.....,.. ..1)....t ,' .' feet. a,,, -,(1-4/czsieti -. . . • o' ' a -,.....„, ----1 1 .. ,•• -der f*T.rtaee. dilcer+4- ''''Gil ; , . „.r- co 0 weNonecosof.the above are within SOO feet of the . .. S Swale-3f kwa=100 feet , "Vneempiste optarreatione writhe nalerwed. 12. I have read this application and agree to comp with II laws regulating the type of work being Pelreimed- a- ,Z. - , C-57 Contractor's Striatum Date - 7 /3. • County Registration Mo. f Z-3 , 4 0 R."...61-f California Cllfoi License NO: .., 0 Z ,, ,, „,,,,,,-,,,77...1.1i,:ic1,7,.T... y,77.. .:,!2,..:,....,..„;1,!'f-,.i-,•it:t;i7:1..;,:.t.; ',,,":}Ntr, OFFICE USE ONLY DO NOT WRITE BELOW 17N.SLINE IlYg1:,q1,77,77737.77..71;7.7.7.•-:,,vi=f;,::,:i'!1, ,-.:,-,:,,..=,,t'''-..1■'',',,i.1-;f,'2,:,..',:1-,-,':,..r-,;,4"'■'1.:..,,,,,'-;-.,-,14 o'-.7-1•.•ii~).'11","•.:,:•::,''i•• ."'••"'-':',:i',.'• ''••-,..."`";;.-2,...l..,',•,.';7::•••••••:,1." 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''' e,"`r. ',1,PW41, .40 ii,,, ...„h, , , 11. , , page 2 of 2 .. 1115113 . : - ,•I . ... t -......... . I .... _.._... . . • 2013-206 . • - • 141 APPLICATION FOR WELL PERMIT L. 4**.v.,,,,z;.:A:1,7gz, County of San Bernardino --IN..''"`44,1 ,41,:' , FV,--', - . '',,..■•- 4 e*:''."'''r . 1 i.'e':a 41,■• Department of Public Health , ,,.,.lt * ,!/-',14011.1e, DIVISION OF ENVIRONMENTAL 4 ..-. HEALTH SERVICES 01-„,...4%,..u-S,A,..1.4-.1. .i. -41,..,,,t4instqz0i.',',--,• `:CIR9c6lhlif,44Er * '' '''' :!,'.- ; ."?''Ff:'.1.:•:A;:k,,, r-L.,.,144r%- '- ,hri,i4t;,-s„,,,:•'-f4k11,44,,,,,,,,,:=41,4004,,g Phone:(800)442-2283 '; — 4,... ,470.0,6,,,; il•- wwW.s bcountv.aovIdehs .i.°1 ' ' 4" .1' 11..-4:3 '■...,'—';:.:,¢ :,.."'...,..,,, 17.-- i?i.. itk:ezi.7,::,• Ario4141,,agallizo,tve? (Please PM", tAto—22 ii;WRIO.,f, :i!: 1. OWNER:Name ....5aelLaili. 3fmcluaLSLLS Items 8 thm ugh 9 to be estimated for new wells,exact for all other wells 5. ANNUAL-AR SEAL: Seal Depth -1 X ft. Site Address (6/.30 S-1,011e-r(Van AVe. Furnished by: 0 Owner 51 Contractor 0 Driyen Conductor Dia. in.,Wall(Gage) • City 5airl (:eXIICUI'd.frAD Zip 92/106 gi Sealing Material eel) . r,Nrotahickness in. Sealing material shell be placed In one continuous paw'. Mailing Address i2c*q5S-La I Oyu flue, -rtgibY) 6. DEPTH OF WELL(feet): '210 4013 City Clic/A-5(5n . zip 90a10 Proposed )4 Existing DIAMETER OF BORE(in.): cs 14 Telephone Number . (I VI) 1 3)— I.:Do 7, CASING INSTiserLED: In standard . *Dross 9 ...Wliii40 0 Steel P31 PD Standard casing 0 Other 2. WELL DRILLER: %I-A -14 Drilling CD• — , Business Name From(ft.) Tg(ft.) Dia.(in.) Wall(Gage) 0-34.9rj Z013 03h/40.322N '5 ,oacW t o o 0 ft.' 9 - pack ryi 3. INTENDED WELL USE(check): From —1 3 Yes D N El Agricultural 0 Horizontal 0 Test CI Cathodic RIA'onitoring/Obseivation Residential Community/PINS/ 12 City 0 0 Dairy r 8. PERFORATIONS(if applicable): Screen fn-ler vat 0 Othe 0 Industrial ill Geothermal 0 Mining From 7 5 to 90 ft. Pumping rate(gpm) 4. 'TYPE OF WORK(check): 9. SEALED ZONES(if applicable): V New 0 Reconstruction 0.DestructIon -. From to 'la It . SECTION MAP--DO NOT FILL IN Scale 1 WA-34 mile 10. LOCATION INFORMATION (a) TOWNSHIP: Tier I 104ange 11 OSection '2-2 ....„1- - Ac 01-1--4-1 (b) As7aors ranee!No. CALii 41 24 6.( __L) NW IA N IA • (c) Latitude and Longitude _ II . , . . Lat St4 °, 03 ., 5e.2.9 6h ., . ... . - "'."-.''*. *4'''*''' '''. ' ' . in it ,.1 to'.'.'*- 464-1 2. TO II or-1- ' . .1 . ' — c1 '' SLOnligd:*o'riLl aid Disposal Site within Wm Mil ;:. ( ) q Miles Ifig,IW 7 4:A vidc1342, N-krVanrti- l>3 Yes 0 No sec — - i 1 , 4-ifir--6. . Location — I_, - - ........ 1—n. ,.. ■■•w --Nr.a .. 11111111111 ' ,VP;*',,T. ..•, „ ..---'G) II ,_ .. .. ., ..,..., ... . _ .. „....,.„ ,,........,,, , ., „. - „•- . —.„, , , „-,•• - I og ,':,-,-‘,4-(,:„--irrilej.-L'.;: ,51.2-11:„.,:;;y .,Z.:-!4KT;...i'Azi;,.-:- :- "...LI:,,,,,,f,2,":,,, ,,A.,,-' 7,:fr .."1 -,,--.,''4,0 4MVA,i-er'zkf,',.,',;,,.?.,6,.4;,.,".,.._4,'.'..■;17Z,t1L'1.,''...1,';:.,'-',-;-...:,-,-4,b sr,.. -t .,0:.!. . SW X 5: V* 444.A.V.i-P-0:' . . ..),,,,,,,,,)-?..#414,-,via. 4t., •,.?4,1A.:::77'4:h..,454:75,,,l',•AitAF,%A.:1=i,e- °,-.7. r .1.-iitir 1..-~0-.4‘;''''''' :'ito*406tiWrrVeAM,ZKMO:48*;';..t,....c6,1' :,,,, i 1 4411,,,,.,';'+'•44'4'r,'W•tr,I.W41,60`1,'"i'l-,,Its$:,.."`,...1+';'':;"‘-'•-'111.,:"::.,!''''''-'-.`•,:''' :' ', ,,,:yg.•6::■"::,:4,';,,,-;::.+I',.i"frris.t,'''..-t",t:.:',4.',`,^:'''.4,.'4..,4,44.,'",:e f■7 t-1.*.`..! „'4",■''' , Page 1 of 2 , ., 1115113 ! ,„ ,.1 ' . • • i ATTACHMENT 3-C r 2013-206 ' 11. PLOT PLAN:see- '� r Assessors Parcel No. 014(t/12160 a� (a) t parapedI1 a to the well aitae,atcatd+ !label the y N foucwing Items:weY totpropetty Yves,other web Onctude eiseitrksteei wool s dispoltd systems(setae sepifcranka,leaching"fele% Mseepage pita,cesspools),bikes and ponds, (mot�"22 way ntourses and anbriate or awl kept. PI -�-�•_.r r-r.. (by indicate the distance,in het,of any of the ieBavving x., _ --' which are Within 600 fl ofthe wet s rr'rrr'_:::::::::, I - w I/ /++ mow,, ``R semis . / /I ....: .. ...... Septic tanks •• I i w R Leading Heide ,1 •i `4 * w R y‘tt f I I j ♦ 1 / 1 E W / F 1 i `r" i takes'sod Ponds ,R watercourses Y.. it ; �M r / • I / I w+r`a // / 1 Animal orfowlkept t ♦ R I �,w 1wZ- ""� s I , .r ' r i Using en arrow,show the approximate ' dcaka�rte pattern of=and a�lrbrvd chow • ``. r s .'/ rodd�itaYie a n 600 aye w`w _� '- 10 Y' �!I feet. (c) None of the above are within 500 feet oldie well sue. Salo.X it,ch.1010 ftaet S • "7ecompleae epplkaelons wil Ibe rrotumrerL// 12. 1 have read this application and agree to c mtply with Iawrs regulating the type of work being performed. �7 Cra/ContractarsSigrmwre _ .......0#15 ---- .}�. � 7 r7�j County Registration No. t ,ra! 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