FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

,oPqMrf•.�o SAN JOAQUIN COUNTY FILE E ENVIRONMENTAL HEALTH DEPARTMENT LOP r. a y• 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION tj•., �P Telephone: (209) 468-3147 Fax: (209) 468-3433 Web:www.sigov.orcl/eh UNIT IV '�C%FpRN 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. D y'�--_32.0-v LP Site Location 712 South Sacramento Street Cross Street West Spruce Street City/State Lodi Zip 95240 APN .OdS-42-R()� Property Owner PG&E Address 3401 Crow Canyon Road City/State San Ramon Zip 94583 Phone 925-383-9517 C-57 Contractor Cascade Drilling,LP Address 3000 Duluth Street City/State w.Sacramento Lic C57-938110 Phone 916-638-1169 Consultant/Sub Cntr Terra Pacific Group Address 13900 Alton Parkway,Suite 122 City/State Irvine Lic 885321 Phone 949-297-4444 Billable Party Terra Pacific Group Address 13900 Alton Parkway,Suite 122 City/State Irvine Zip 92618 Phone 949-297-4444 GIS Coordinates:X 3g. /._475— Y -r2''Z7?_60 CONSTRUCTION WORK TO BE PERFORMED: ❑-1 NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ❑SOIL BORING IDs ❑WELL IDs Q OTHER IDs PRSG-1 through PRSG-6 TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 3" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: 1/4 _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC 8 OTHER Teflon 6 ®SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL 4.5 or 6.5 bgs TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE _❑SOIL BORING M PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes [M No(MAXIMUM FREE FALL DEPTH IS 30 FT) _❑INJECTION(Le.Air sparge.ozone)N HAND AUGER upper 5 feet GROUT SPECIFICATIONS Neat Cement with 5%Bentonite _❑OTHER: ❑OTHER: APPROX.BORING DEPTH see Table 4 ®BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING®No❑Yes:Casing Dia: Casing Depth: Boring Dia COMMENTS:see attached Table 4 and Figures 2 and 4 for construction and location details 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 - GROUTSPECIFICATIONS ❑EXPLOSIVES FRoM TO FT BELOW SURFACE - TREMIE-TYPE TO BE USED-❑AUGERS-I] HOSE-0 PIPE- - ----- - ID MUSHROOM CAP-AT-(>3 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 Regulatlo ,andall epp Icable California laws. Signed Title/Company Pincipal Engineer /Terra Pacific Group Print Name Matt Derby Date DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESS- 717. Sr 2 E , 60bl WORK PLAN DATED J✓3N /3 �/ APPLICATION ACCEPTED BY J. yp f}Ku" DAT REA GROUT INSPECTION BY FINAL INSPECTION BY �l_ATE 27Z"le 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# $130x L/ t^_vutv%bR /�iS iS SR# 7� 3v`I Zqo 3 3QO (3500 PR# (2900) C-57 ti WC ✓ WAIVER C-57 LETTER OF AUTHORIZATION TO SIGN PERMITy ENCROACHMENT DOCk'✓4 EHD 29-01 7/24/14 WELL PERMIT APP