SR0071158 - Laserfiche WebLink

Home Browse Search

ORIGINAL SAN JOAQUIN COUNTY �.• ,,.err •.o -r, a ENVIRONMENTAL HEALTH DEPARTMENT LOP y 600 East Main Street, Stockton, CA 95202-3029 SITE MITIGATION . �4.. ;P.. Telephone: (209) 468-3147 Fax: (209) 468-3433 Web:www.si9ov.orq/eh 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 1137 S. Stockton St Cross Street Navy Drive City Stockton Zip 95206 APN 163-260-22 Property Owner Phillips, John B& Bonnie Address 1133 Bristol Ave City Stockton Zip 95204 Phone (209)944-0909 C-57 Contractor Advanced GeoEnviron.Address 637 Shaw Road City Stockton Lic 680227 Phone (209)467-1006 Consultant/Sub Cntr Advanced GeoEnvirpgdress 837 Shaw Road City Stockton Lic 680227 Phone (209)467-1006 Billable Party Advanced GeoEnviron. Address 837 Shaw Road City Stockton Zip 95215 Phone (209)467-1006 GIS Coordinates:X 37.938270 Y -121.301328 37. 3 -lzl- 3003 CONSTRUCTION WORKTO BE PERFORMED: ®NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ❑SOIL BORING IDs ®WELL IDs Six Soil Borings B16-B21 ❑OTHER IDs TYPE&#OF WELUBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA OF BOREHOLE 2" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS NA TYPE OF CASING ❑STEEL ❑PVC ❑ OTHER _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL 10- 15 FeetrREMIE TYPE TO BE USEDi ❑AUGERS ❑HOSE XJ PIPE _LjjJ SOIL BORING IN PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes fN No(MAXIMUM FREE FALL DEPTH IS 30 FT) _❑INJECTION lie Air Soaroe.Ozone/❑HAND AUGER GROUT SPECIFICATIONS 94 Ib baa norland cement mixed with 6 gallons of water _❑OTHER ❑OTHER: APPROX.BORING DEPTH 10 to 15 feet ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING l$No❑Yes:Casing Dia: Casing Depth: Boring Dia COMMENTS: 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 ElHOSE [-] PIPE F)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 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulations,and all applicab Califorpia laws. Signed Title/Company Professional Geologist Print Name Brian Millman Date 08 December 2014 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESS U ti� � 'OC 1-� 1 C't WORK PLAN DATED :� �NC_ O 1 APPLICATION ACCEPTED BY ^ IO W KK6✓U DATE 1I EA /6, 99 GROUT INSPECTION BY FINAL INSPECTION BY J NA w ATE 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# /o7 q &uUM2 12-10,1,E SR# 2//50 RO# .'fit v? 35U (ssoo) PR# (2900) C-57 WC WAIVER C-57 LETTER OF AUTHORIZATION TO SIGN PERMITy ENCROACHMENT DOC EHD 29-0 01/13/12 WELL PE"RMI