Laserfiche WebLink
FILE COPY <br /> San Joa qui County <br /> A Environmental Health Departure ) i; SITE <br /> 304 East Weber Avenue,3rd Floor, Stockton,Ck 99A `�' ITIGATION <br /> (209)468-3449 Fax: (249)468-3433:Web: www.sjgov.org/ehd <br /> . �#q.... ...,`' A� -•- � 2��7 UNIT IV <br /> Well Peri Init ApplicatioAPR , <br /> NON-REFUNDABLE PERMIT EXPIRES t YEAR FROM DATE ISL ,I RR r <br /> ES <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work describdd. 7h app Tical ori s made in compliance with San <br /> Joaquin County Development Title,Chapter 5-1115.3 and the Standards of San Joaquin County Erivironmental Health Department. <br /> WELL Location- — Grant Line .Rd Trac 95376 Assessors <br /> 233-460-02 <br /> _ ��_____�T S[Cross Stroet _ City Y Zip Parcel# <br /> PROPERTY FJ Leonardo Castro <br /> ' <br /> Owner � Son, Inc. Address PO Box 20568; City ValleY '{ Zip 94546 phone# 510-886-2040 <br /> ;3 Valley } <br /> C-57Contractor 'Fisch Drilling' —Address-399 SIieri''s Place CitySpri9y Zip95252Lie#683865Phone# 209-772-3570 <br /> Ground Zero <br /> Consultant/Sub Cntr. Analysis, Inc. J Address 1714 .Main Street CityEs:calon Lic# Phone# 209-838-9888 <br /> GIS Coordinates:X T J Y _l ZI•� � Township 2S Range 5E Section- 21A <br /> WORK TO BE PERFORMED: <br /> X-NEW WELL I BORING SCPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER)` 0 DESTRUCTION (choose type below) <br /> SOIL 80RING# S 24 n OVER-BORE. DIAMETER <br /> VYELL# [I PRESSURE GROUT <br /> 0.Other' - GROUT SPECIFICATIONS <br /> COMMENTS: Boring located in the parking Jot of''the neighboring shopping center <br /> TYPE OF WELL ` INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> II MONITORING 0 HOLLOW STEM DIA.OF BOREHOLE 1 75"a MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: <br /> 0 EXTRACTION 0 AIR HAMMER/DRIVEN CASING1THICKNESS TYPE OF CASING:'0 STEEL O PVC 010THER: <br /> 0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL 10' TREMIE TYPE TO BE USED: GAUGERS 0 HOSE <br /> p AIR SPARGE/OZONE PUSH POINT(GP or CPT)GROUT'SEAL PUMPED: 0 Yes .p No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30) <br /> ;IrSOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS Neat cement grout <br /> 0 OTHER: 0 OTHER APPROX.'BORING DEPTH 10BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (if YES,list specifications in comment section) <br /> COMMENTS: <br /> NOTE: OFFSITE BORINGS REQUIRE.ACCESS AGREEMENT OR ENCROACHMENT,IPERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, Rules Re�and all applicable California State Law <br /> Signed x Title/Company <br /> Print Name t�"i��1+0/ <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE, ADDRESS: <br /> WORK PLAN DATED, O <br /> Application Accepted By Date Issued;- --„-rr. Area <br /> Grout Inspection By ate Final Inspection By <br /> Destruction Inspection By Date F <br /> COMMENTS I CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> 4 r <br /> PE CODES FEE INFO AMOUNT REMITTED CHECK# REC'D BY DATE i! PERMIT I SERVICE REQUEST:#; INVOICE <br /> o��g SR# <br /> C-57WC -WAVER_ C-57 Letter of„Authorization to sign per _mitEncry,aeltrtitent doc <br /> EHD 29-02-001 <br /> n� <br /> 6/22/04 <br />