Laserfiche WebLink
o.P4 " c SAN aIOAQUIN COUNTY <br /> a oEt,o <br /> a' —` ` tis ENVIRONMENTAL HEALTH DEPARTMENT <br /> �' AUG 2 5 2016 <br /> '• 1868 Hazelton Avenue, Stockton, CA 95205-6232 <br /> Z�kb'`''�P Telephone:(209) 468-3420 Fax:(209) 468-3433 Web:www.smcehd.com IENVIRON ;, <br /> SITE MITIGATION WELL & BORING PERMIT AI?PLICATIM4LTH DE r <br /> For Wells and Borings Used for Contaminant Investigations ',and Remediation <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. <br /> This application is made in compliance with San Joaquin County Development Title,Chapter 9-1115.3,anc the San Joaquin County Well Standards. <br /> Job Address 73 Stewart Road(River Islands) City/State/zip_LathrOD.CA 95 330 Phone <br /> Cross Street Cohen Road APN 213-300-07 `l� <br /> PropertyOwner* Califia LLC <br /> Phone (209)879-7900 <br /> Address 73 Stewart Road ✓ City/StatelZip Lathroo. CA 95 330 <br /> G-57 Contractor Confluence Environmental Inc. License# 913194 Phone (949)716-4971 <br /> Address 3308 EI Camino Ave. Suite 300#148 City/state/Zip Sacramento CA 95821 <br /> Consultant(Sub-Contractor Hydro Focus Inc. License# Phone (530)759-2484 <br /> Address 2827 Spafford Street City/State Zip Davis CA 95618 <br /> CONSTRUCTION WORK TO BE PERFORMED:`Note: Offsite BoringsM/ells Require Access Agreemen s or Encroachment Permits <br /> TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC SO ❑STOVE PIPE <br /> ❑ EXTRACTION(Vaporlwater) ❑ HAMMEWDRIVEN DIA,OF BOREHOLE ❑MULTIPLE CASINGS MULTI-LEVEL WELL CASING DIA <br /> ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER <br /> ❑ SOILBORING ❑ PUSH POINT(GP/CPT) CONDUCTORCASING [I Yes 0 N Boring Dia: _Casing Dla: Casing Depth: <br /> ❑ INJECTION(Air Soma..oor) ❑ HAND AUGER GROUTSEALDEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE <br /> ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freetall Depth is 30 Fl) <br /> WEW SOIL BORING IDs GROUT SPECIFICATIONS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECKpu THAT APPLY) <br /> #WELLS TO BE DESTROYED 1 E OVER-BORE DIAMETER of 8 inches to depth of 16 feet <br /> WELL IDs 15 ❑PRESSURE GROUT To depth of feet below surface <br /> GROUT SPECIFICATIONS neat cement El EXPLOSIVES From _feet below surface <br /> TREMIE TYPE TO BE USED 0 AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feel below urface or feel below surface if>3 feel <br /> COMMENTS: <br /> I hereby certify that lam authorized to complete this application and that the work will be done in accordance with <br /> S1p/rLnJo_a�quin TCounty Ordinance Codes and Standards,and all other applicable California laws. <br /> Signed "'`-�" I" " Title/Company President/Confluence Environmental <br /> Print Name Megan erns Date 8/23/2016 <br /> ,f� �� /� �� �DEPARTMENT USE ONLY )/ <br /> Application Accepted By: /!/Aa&Koh'/ Date Issue �3// <br /> 4 <br /> Grout Inspection By/Dates: <br /> Destruction Inspection By/Dales: ,— b <br /> Faciltt /Site Information <br /> FLFA Name FA Address FA# 0o2j2//� PR# o.Sq,' <br /> A WP viewed By Work Plan Dale Zvr /F <br /> G57 ❑C-57 Authorization for Other to Sign Permit Workers Comp ❑Workers Comp Waiver DEncroa =ssAgreement ead Agency Approval I <br /> COMMENTS(CONDITIONS: <br /> SR TYPE I PE SC FEE INFO AMT REmrrrEDj CHECK#I RECV'D BY I DATE SERVICE REQUEST# INVOICE# <br /> Work Plan I I I I I i <br /> Permit 29ol 3(3 $139x 1 111,35) � 76003 <br /> EHD 29-01 6-23-2015 Site Mitigation Well Permit Application <br />