FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

FILE COPY SAN JOAQUIN COUNTY y; �+ ENVIRONMENTAL HEALTH DEPARTMENT LOP ^C��S 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION �pN UNIT IV •.� -I :P� e ephone:.,(209) 468-3147 Fax: (209) 468-3433 Web:www.sigov.orq/eh 01A 1A uvo� Aft ' Ev, (WELL & BORING PERMIT APPLICATION 4�4R`1 ILA 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 Standards of the San Joaquin County Environmental Health Department. Site Location 140 West Harding Way Cross Street North Pacific Avenue City/State Stockton Zip 95204 APN 137-070-53 Property Owner Farouk Diab Address 10608 Oakwilde Avenue City/State Stockton Zip 95212 Phone 209-931-1044 Advanced GeoEnvironmental In gy�w P.o:.d coccon 68022'I C-57 Contractor address X3Sk 7 City/State Lic Phone 209-967-1006 Advanced GeoEnvironmental Inc. 837 Shaw Road Stockton 690227 Consultant/Sub Cntr Address City/State Lic Phone 209-467-1006 Advanced GeoEnvironmental Inc. 937 Shaw Road Stockton 95215 209-467-1006 Billable Party Address City/State Zip Phone GIS Coordinates:X 7 9yl( Y -(2-L M 77- CONSTRUCTION WORK TO BE PERFORMED: ❑NEW WELUBORING(CPT,GEOPP.OBE,HYDROPUNCH,HAND-AUGER,OTHER) ® SOIL BORING IDs VP-1 through VP-5 ❑WELL IDs ❑OTHER IDS TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 1."" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS N/A TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER "®SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL s and 10' TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ®PIPE _❑SOIL BORING El PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) _❑INJECTION(i.e.AirSparge,Ozone)❑HAND AUGER GROUT SPECIFICATIONS Portland cement 6 gallons of water per 94 lb bag _❑OTHER: ❑OTHER: APPROX.BORING DEPTH 56 and 10 C]BOLTED TRAFFIC BOX OR EI STOVE PIPE COMMENTS: CONDUCTOR CASING EINo❑Yes:Casing Dia: Casing Depth: Boring Dia: NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #OF WELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER of INCHES TO DEPTH OF FT WELL IDs: ❑PRESSURE GROUT To DEPTH of FT BELOW SURFACE GROUT SPECIFICATIONS ❑ EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED:ElAUGERS ❑HOSE ❑ PIPE ElMUSHROOM CAP AT(?3 FT) FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby ce � iat I hay prepared this application and that the work will be done in accordance with San Joaquin County Ordinances,Rules and Regulatio ,and all a ica Califo s. Signed Title/Company Project Geologist Print Nam Daniel Villanueva 01/05/2014 Date L' DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESS _i U 6U, (4,9 eDiAi6- ?Ze KIZA) WORK PLAN DATED ) /V u 4 APPLICATION ACCEPTED BY .( . Yr, u�� DATE ISSUED I—/ Z "/ 5 AREA GROUT INSPECTION BY FINAL INSPECTION BY DATE DESTRUCTION INSPECTION BY DATE COMMENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO 11 INVOICE p REQUEST PR# a. Ivy $130x C� 6lU�8 Coc[1V l"'��/`J SR# 2Ro 3�� RO# 3500) PR# (2900) C-57_ WC r/ WAIVER 4242aC-57 LETTER OF AUTHORIZATION TO SIGN PERMIT Li ENCROACHMENT DOC EHD 29-01 7/24/14 WELL PERMIT APP