FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY " ENVIRONMENTAL HEALTH DEPARTMENT LOP 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION Telephone:(209)468-3147 Fax:(209) 468-3433 Web:www.siaov.org/ehd UNIT IV 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 Standards of the San Joaquin County Environmental Health Department. Site Location 1050 S.Diamond Street Cross Street or.Martin Luther King Jr.Blvd City/Slate Stockton,CA Zip 95205 APN 155-32-019 Property Diamond Foods Owner Address 1050 S.Diamond St. City/Slate Stockton,CA Zip 95205 phone 209.951.2188 C-57 Contractor Gregg Drilling&Testing,Inc Address 950 Howe Rd. City/State Martinez,CA Lic 485165 Phone 925.313.5800 Consuitant(Sub Cntr Cardno ATC Address 1117 Lone Palm Ave.,Suite 2018 City/Stale Modesto,CA Lic 95351 Phone 209.579.221 Billable Party Cardno for Diamond Foods Address 1117 Lone Palm Ave.,Suite 2018 City/State Modesto,CA Zip 95351 Phone 209.579.221 GIS Coordinates:X Y CONSTRUCTION WORK TO BE PERFORMED: NEW WELL/BORING(CPT,GEOPROSE,HYDROPUNCH,HAND-AUGER,OTHER) 0 SOIL BORING IDs Q WELL IDs OBSW-s,OBSW-d,MWAR ❑OTHER IDS TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS 'I Q MONITORING 0 HOLLOW STEM DIA.OF BOREHOLE 12_ (21 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: 2 EXTRACTION:Vapor/Water 0 HAMMEMDRIVEN CASING THICKNESS Schedule 40 TYPE OF CASING: 0 STEEL 0 PVC D OTHER _0 SOIL VAPOR PROBE D MUD ROTARY DEPTH OF GROUT SEAL 13 TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE D PIPE _❑SOIL BORING ❑PUSH POINT(GPI CPT) GROUT SEAL PUMPED:0 Yes D No(MAXIMUM FREE FALL DEPTH IS 30 FT) 2-0 INJECTION(L,.Alr Soame.Oz,,)O HAND AUGER GROUT SPECIFICATIONS neatcement _O OTHER: n OTHER: APPROX.BORING DEPTH 75' 0 BOLTED TRAFFIC BOX OR D STOVE PIPE CONDUCTOR CASING 0 No 0 Yes:Casing Dia: Casing Depth:_ Boring Dia' COMMENTS:Thw inipr•tinn veliq, (�RCNI c and 0RRWr d mill bP nented in theg me borehole MW-4 will be ren/ ran vt ith MN/4R NOTE: OFFSITE WELLS&BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) 1 #OF WELLS)TO BE DESTROYED Q OVER-BORE DIAMETER OF 8 INCHES TO DEPTH OF S5 FT WELL IDs: MW-4 Q PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE GROUT SPECIFICATIONS neat cement ❑EXPLOSIVES FROM TO FTBELOW SURFACE TREMIE TYPE TO BE USED:❑AUGERS Q HOSE ❑PIPE ❑MUSHROOM CAP AT(>3 FT) FTBELOW SURFACE COMMENTS MWA will be drilled out and replacement MW-4R will be installed in sam2 borehole xi ting bore is 8" 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County Ordinances,Rules and Regulatiioo11a,�and all ap ca le California laws. Signed J-K�J�. Title/Company Branch Manager/Cardno Print Name anne Homsey Date 5/12/15 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITF ADDRESS i C>5� I�j f�AA4 A M ^e S- _ --S±C2LL moi WORK PLAN DATEDy /� APPLICATION ACCEPTED BY �^1(_ty,��riy� DATE ISSUED S / S AREA GROUT INSPECTION BY U�e1nM[ d v FINAL INSPECTION BY L ,F c... DATE DESTRUCTION INSPECTION BY �I c cM DATE b 2 f COMME NTS/CON DITI ONS: ACCOUNTING ONLY: AID# FAC It PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE I RO# INVOICE p REQUEST FIR 1 0 I s na. SR#—+ZZ.NO 90Z 17,oxt p 03110 110 s i4 �S s� zZ� �qo3q0 3Rd %(Or - 90.2 .Z C-57_1[ WC WAIVER IC-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC END 29-01 5/09/12 WELL PERMIT APP