FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

nP4 •ry••o SAN JOAQUIN COUNTY LOP DEPARTMENT DEP H ENVIRONMENTAL EALA a� � SITE MITIGATION 600 East Main Street, Stockton, CA 95202-3029 UNIT IV d..;,,;, ::•:� Telephone:(209)468-3454 Fax: (209)468-3433 Web:wwwsisaov.orstle 4coaN 0�2V WELL S BORING PERMIT APPLICATION qU11� FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND R �A,T6Q.NAe1 ZQtQ NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED PLC'I1plyl{/TT'YejyI Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application isCmae�N[ts�a�l /7 Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health Department. �[•�1. 15135 & 14501 W EIGHT MILE ROAD STOCKTON 95219 069-081§21 Site Location Cross Street City Zip APN Property EMPIRE FIELDS LLC 7277 PACIFIC AVE #4 STOCKTON 95207 Owner Address City Zip Phone C-57 Contractor ADVANCED GEOENVIRONMEd &Ss 837 SHAW ROAD City STOCKTON LicC57-680227 Phone 209-467-1006 Consultant/Sub Cntr VANCED GEOENVIRONMENrrTAALassB37 SHAW ROAD City STOCKTON LIC Phone Billable Party Address City Zip Phone 209-467-1006 HERMAN & HELEN'S MARINA 15135 W EIGHT MILE ROAD STOCKTON 95219 209-951-4634 GIS Coordinates:X Y CONSTRUCTION WORK TO BE PERFORMED: U NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) xMSOIL BORINGIDs IB-1, IB-2, I13-3, IB-4, IS-5, IS-6, B-30A, B-30B, 13-21A, B-25 ❑WELL IDs ❑OTHER IDs TYPE&#OF WELUBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 1-5 ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: — ❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TO - SFC TREMIE TYPE TO BE USED: ❑AUGERS [I HOSE t 'PIPE XX SOIL BORING XXE]PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) XXff INJECTION(i.e.Alr Soerne.Omne1❑HAND AUGER GROUT SPECIFICATIONS TYPE II PORTLAND _❑OTHER: ❑OTHER: APPROX.BORING DEPTH VARIES ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING$No❑Yes:Casing Dia: Casing Depth: Boring Die: COMMENTS: DEPTHS: IB-1 to IB-3 (15 ft) ; IB-4 to IB-6 (25 ft) ; B-30A & 2-30B (25 ft) ; B-21A (15 ft) ; B-25 (55 ft) 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:❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP AT(>3 FT) FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE)FOR INSPECTION APPOINTMENTS I hereby certify that I haveprepaired this application and that the work will be done in accordance with San Joaquin County Ordinances,Rules and Regulation?,an alla i �- . AnvANcan GEoeNVIRONMeNTAL, INC Signe 1Title/Company Print Name ARTHUR DEICKE Date 11 AUGUST 2010 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESS WORK PLAN DATED APPLICATION ACCEPTED BY DATE ISSUED AREA GROUT INSPECTION BY FINAL INSPECTION BY DATE DESTRUCTION INSPECTION BY DATE COMMENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMR T REMITTED CHECK# RECV'D BY DATE SERVICE ROEQUEST PR## INVOICE $122 x SR# RO# 3500 PR# 2900 C-57 WC WAIVER C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC EHD 29-01 07/28/10 WELL PERMIT APP