SR0069529 - Laserfiche WebLink

Home Browse Search

uvxpm SAN JOAQUIN COUNTY ORIGINAL c APR 2 4 2014 ;Q a ENVIRONMENTAL HEALTH DEPARTMENT LOP NlIH[)NuNT till, CA 95205-6232 .. Stockton 1868 East Hazelton AvenueSITE MITIGATION P , , UNIT IV •4��ii � "I-� one:[c(209) 468-3454 Fax: (209) 468-3433 Web:www.sipov.org/ehd �F O RN�p CRM " ti 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 2122 South Airport Way Cross Street East 8th Street City Stockton Zip 95406 APN 169-162-01 Property Owner Ralph Lee White Address 2230 South Airport Way City Stockton Zip 95206 Phone 209-464-8526 Advanced GeoEnvirenmental Inc. 837 Shaw Road Stockton C-57 Contractor Address City Lic 660227 Phone 209-467-1006 Advanced GeoEnvironmental Inc. 837 Shaw Road Stockton 680227 209-467-1006 Consultant/Sub Cntr Address City Lic Phone Advanced GeoEnvrionmental Inc. 837 Shaw Road Stockton 95215 Billable Party Address City Zip Phone 209-467-1006 GIS Coordinates:X 37. R 3 Lo Y -12-( • 74G8 CONSTRUCTION WORK TO BE PERFORMED: E] NEW WELUBORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) R SOIL BORING IDs B6, B7, BB, B9 M WELL IDs Vl through V9 ❑OTHER IDs TYPE&#OF WELUBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE". and 1.20 MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: none _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS N/A TYPE OF CASING. ❑STEEL ❑PVC El OTHER probe tip 9 171 SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL 4 "d to TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE 4 ®SOIL BORING ®PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ®No(MAXIMUM FREE FALL DEPTH IS 30 FT) ❑INJECTION(i.e AirSparcle.Ozcne)El HAND AUGER GROUT SPECIFICATIONS Portland cement (borings) and Bentonite (vapor probes) vapor probes) an (borings) ❑OTHER: ❑OTHER: APPROX.BORING DEPTH M BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth Boring Dia: COMMENTS: see attached work plan, site pian, and Regional Water Quality control Board approval letter. 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 0 HOSE [7] PIPE ❑MUSHROOM CAP AT L3 FT) FT BELOW SURFACE COMMENTS 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 Regulations,and pH pli Ie California Laws. Signed J Title/Company Project Geologist/AGE Print Name Daniel J. Villanueva Date 04/24/2014 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE SITE ADDRESS Z S , /31 Q S f'G&7-w a� TwKN Jo np WORK PLAN DATED /7 f 2 i - APPLICATION ACCEPTED BY J /df'}K,4wt DATE ISSUED y"Z(' AREA G GROUT INSPECTION BY FINAL INSPECTION BY DATE DESTRUCTION INSPECTION BY DATE COMMENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO# INVOICE REQUEST PR# d1�10 $125 x /zs SR# 15 Z 9 Ato3 375- 37S /4-z 39/v / �oun.i� �i� 2z-/`( sop 2905 ►d..S 1'ZS (2oS'e(, 9530 C-57�- WC / WAIVER C57 LETTER OF AUTHORIZATION TO SIGN PERMIT r/ ENCROACHMENT DOC wigq