WORK PLANS - Laserfiche WebLink

Home Browse Search

e SAN JOAQUIN Environmental Health Department I_ --COU NTY--- cstrroa`'w (;,entnr,<<, ntnwl lu, SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Advance Notice Required For All Inspections CALL (209) 953-7697 For INSPECTIONS 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 Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. Job Address 26700 South Banta Road City/State/Zip Tracy,CA 95304 Phone (408)599-4030 Cross Street W Linne Road APN 252-010-070-000 Property Owner* Union Pacific Railroad—Scott Selken Phone (402)544-4159 Address 1400 Douglas Street Stop 1030 City/State/Zip Omaha,NE 68179 C-57 Contractor Gregg Drilling License# 1044456 Phone (925)255-6263 Address 2100 Goodyear Road Clty/State/Zip Benicia,CA 94510 Consultant/Sub-ContractorGeosyntec Consultants License# 766859 Phone (510)285-2682 Address 1111 Broadway,6th Floor City/State/Zip Oakland,CA 94607 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMERIDRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL Cl PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION wrsoarmozonel ❑ HANDAUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: [I AUGERS ❑HOSE [I PIPE ❑ OTHER ❑ OTHER GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED 1 OVER-BORE DIAMETER of 8.25 inches to depth of 25 feet WELL IDs MW-6(see attached Work Plan) PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Portland cement mixed with 3-5%bentonite gel ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS []HOSE ❑x PIPE feet below surface if>3 feet COMMENTS: Well will be tagged to verify total depth before destruction- 9/5/25: To pressure grout due to utilities per contractor's request. To remove Standpipe, no overdrilling/mushroom cap 1 hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed Title/Company Project Manager/Gregg Drilling, LLC Print Nard Ryan Lea Date 4/28/2025 // DEPARTMENT USE ONLY / Application Accepted By: a _ / Date Issued: 5 L ( ( Z )! Grout Inspection By/Dates: Destruction Inspection By/Dates: �ao5� 10'l Facilit /Site Information FA Name l FA Address ( vc, FA# i r L PR# i 7 G G Z' FA PE 2 (, �' WP Reviewed By Work Plan Date Z 'j , �— ❑C-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR COMMENTS/CONDITIONS: -I—, ��-�y, VA Lt.,,_ L2 (� &I WP TYPE PE SC I FEE INFO JAMT REMITTED1 CHECK#I RECV'D BY I DATE WELL PERMIT## INVOICE# Permit 20tb2. -�I3 $172x t �� v 4. - i i i W1 9-5001D7 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 J, F 209 464-0138 1 www.sjcehd.com EHD 29-01 08-01-2024 �' -� `� ,y Site Mitigation Well Permit Application