Laserfiche WebLink
pn!uN-�. ° , SQ NU OQQ U I N Environmental Health Department <br /> COUNTY-- <br /> ``°�trFoa�'4 Greatness grows here <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 24 Hours Advance Notice Required For All Inspections <br /> CALL (209) 953-7697 For INSPECTIONS <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,and the San Joaquin County Well Standards. <br /> Job Address 3105 S.El Dorado Street City/State/Zip Stockton CA 95206 Phone (209)466-3554 <br /> Cross Street W.IvyAvenue APN <br /> Property Owner* El Dorado Land Holdings LLC Phone (209)4663554 ext 322 <br /> Address PO.Box6632 City/State/Zip StocktonCA95206 <br /> C-57 Contractor Bala Exploration Inc License# 80431E Phone (760)743-7678 <br /> Address 246 Vista Grande Glen City/State/Zip Escondido CA 92025 <br /> ,,v oConsultant/Sub-Contractor Innovative Environmental Solutions(IES) License# 962676 Phone (760)632-2330 <br /> Address 839 Second Street Ste.2 City/State/Zip Encinitas,CA 92024 <br /> CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br /> TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE <br /> ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN 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 /> ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: <br /> ❑ INJECTION(Air soarge,ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE <br /> ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) <br /> WELL/ BORING IDs GROUT SPECIFICATIONS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br /> #WELLS TO BE DESTR YED 8 ($J OVER-BORE DIAMETER of 8-10 inches to depth of 30-61 feet <br /> WELL IDs �M�yv4,M M 9,M OA,M 1 B,and -1 PRESSURE GROUT To depth of 3 feet below surface <br /> GROUT SPECIFICATIONS r ❑EXPLOSIVES From to feet below surface <br /> TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ®PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet <br /> COMMENTS: <br /> I hereby certify that I am authorized to complete this application and that the work will be done in accordance with <br /> ante Codes and Standards,and all other applicable California laws. <br /> Signed / ' '�"— Title/Company President,IESIAgenl <br /> Print Name Michael Davis Date August 15,2025 <br /> DEPARTMENT USE ONLY <br /> Application Accepted By: Date Issued: \ l2 5r <br /> Grout Inspection By/Dates: —L <br /> Destruction Inspection By/Dates: <br /> Facilit /Site Information <br /> FA Name Lu r y�r L a l2 L t tq,,, j FA Address FA# a c, PR# A 5 !� o <br /> FA PE 2 at WP Reviewed By Work Plan Date <br /> 19C-57 57 Authorization for Other to Sign Permit orker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement IaLead Agency Approval gMFR <br /> COMMENTS/CONDITIONS: �y�w r<LcS��rur�-�oh5 kDr 5��-C I ✓j i�4�c <br /> AP 50a,514 <br /> WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# <br /> Permit 2q,pa 31 $141'x WP450101al <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 29-01 08-01-2024 2L> 2 Z��'Z�� Site Mitigation Well Permit Application <br />