Laserfiche WebLink
FILE COPY <br /> o t ,� San Joaquin County <br /> r. G Environmental Health Department SITE <br /> 600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br /> (209)468-3449 Fax: (209)468-3433 Web: www.sjgov.org/chd UNIT IV <br /> ogsR'P Well Permit Application Io (/�• <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 applicationis made I Nance with San <br /> Joaquin County Development Title,Ch pter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> /�, EL DORADO Assessors <br /> Cog Rjw <br /> WELL Location j Foss Stree� � ,f City STOCKTON Zip 95204q Parcelp# G� � <br /> PROPERTY <br /> rECity Of Stockton Address_q N r ULA City Stockton Zip 95204 Phone# t � ° y I <br /> I <br /> C57 Contractor BOART LONGYEAR Address 510 5TH STREET City COLUSA Zip 95932 Lic#694686 Phone#.562.906-1960 <br /> Consultant/Sub CntrSECOR INTER. INC . Address 3017 KILGORE RD City RAND NCCHO Lc#NA Phone# 916-861-0400 <br /> GIs Coordinates:X-121:29465,649796Y 37.96770,4203603 Township 1 NORTH Range 6 EAST Section 3 <br /> WORK TO BE PERFORMED: <br /> $1 NEW WELL/BORING (CPT,GEOPROSE,HYDROPUNCH,HAND-AUGER,.OTHER•) (]DESTRUCTION (choose type below) <br /> 0 SOIL BORINGG,# 0 OVER-BORE, DIAMETER <br /> WELL# DMW- 0 PRESSURE GROUT a <br /> 0"Other GROUT SPECIFICATIONS } <br /> COMMENTS: DMW-10 will be advanced using a sonic.drilling rig Encroachment Permit if 71689„Revocable#07-27W <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ;j MONITORINGS 0 HOLLOW STEM DIA.OF.BOREHOLE 8.25 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA:2-INCH <br /> 0 EXTRACTION AIR HAMMER/DRIVEN CASING THICKNESS SCH.40 TYPE OF CASING: 0 STEEL )0 PVC 0 OTHER: <br /> 0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE <br /> 0 AIR SPARGE!OZONE 0 PUSH POINT(GP orOPT)GROUT SEAL PUMPED: DYes D No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> 0 SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS <br /> 0 OTHER: BOTHER SONIC APPROX.BORING DEPTH 75 FEET BOLTED TRAFFIC BOX or 0 STOVE PIPE I <br /> CONDUCTOR CASING PROPOSED (if YES,list specifications in.comment section) }i <br /> COMMENTS: During advancement soil samples will be collected continuously using a 20-foot core barrel. { <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> t <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. 1 <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, Rules and Regulations,and all applicable California State Laws. <br /> Signed xTitle/Company SECOR INTERNATIONAL INCORPORATED <br /> . <br /> ^�'�-^''-----1 <br /> Print Name MICHAEL SPERBER Date�� <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE, ADDRESS: I6 G'• (T'�^-��`f 6OP D <br /> WORK PLAN DATED: <br /> Application Accepted By Date Issued Ar <br /> Grout Inspection By Dat Final Inspection B a 0; D <br /> i <br /> Destruction Inspection By Da e <br /> COMMENTS/CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEEINFO AMOUNT REMITTED CHECK# REC'D BY DATE PERMITISERVICE.RECUEST# INVOICE <br /> SR# 30 3 <br /> C-57� WCC/ -WAIVER_ C-57 Letter of Authorization to sign permit_Encroachment doc <br /> r,HD 29-02-001 WEB D y <br /> 9/11/2007 7 � <br />