FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

oA0.`'f"' c SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT .y y { 1868 Hazelton Avenue, Stockton, CA 95205-6232 �.Q••..J;:;.a�a Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sicehd.com �rfiotiz SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings Used for Contaminant Investigations and Remediation NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 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 701 East Charter Way CitylState/Zip Stockton, CA, 95206 Phone 209-467-0305 Cross Street Stanislaus Street APN 147-343-11 Property Owner" Swaran Chouhan Phone 209-467-0305 Address 1632 Paola Place City/State/Zip Manteca, CA, 95337 C-57 Contractor BC2 Environmental License# 9697.58 Phone 714-412-2990 Address 1150 W. Trenton Avenue City/State/Zip Orange, CA, 92867 ConsultantlSub-Contractor Advanced GeoEnvironmental License# 680227 Phone 209-467-1006 Address 837 Shaw Road- City/State/Zip Stockton, CA, 95215 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite BoringshVells Require Access Agreements or Encroachment Permits TYPE OF WELLBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporMater) ❑ HAMNIER/DRIVEN DIA OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOILVAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Sparge.Ozone l ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS❑HOSE❑PIPE ❑ OTHER ❑ OTHER GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefal 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 2 ®OVER-BORE DIAMETER of 8 inches to depth of 151 feet WELL IDs MW-8 and MW-9 ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED []AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feel COMMENTS: See .work plan for additional details; CMT wells to be overdrilled using sonic drilling techniques. I reby certify that I am authorized to complete this application and that the work will be done in accordance with San J in County Ordinance Codes and Standards,and all other applicable California laws. Signed Title/Company Project Geologist/AGE Print Name Daniel Villanueva Date 10/27/2015 DEPARTMENT USE ONLY Application Accepted By: ��(/I/�� A7- Date Issued: i Grout Inspection By/Dates: Destruction Inspection By/Dates: Facili /Site Information FA Name FA Address FA# PW FA PE I WP Reviewed By I Work Plan Date ❑C•57 ❑G57 Authorization for Other to Sign Permit ❑Workers Comp ❑worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR COMMENTS/CONDITIONS: SR TYPE PE Sc FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE REQUEST# INVOICE# Work Plan 7 Permit ZAZ jl ') $130x a.. ZC0 12jt`O Cr1l l7//j_ j:ll�u/ jSl7 EHD 2M1 6-23-2015 Site Mitigation Well Permit Application