FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY FILE p ENVIRONMENTAL HEALTH DEPARTMENT LOP bid ' 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION • 4 ""��;.P . Telephone: (209) 468-3147 Fax: (209) 468-3433 Web:www.sigov.org/ehd UNIT IV ��FOR 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 1320 W. Weber Ave Cross Street West Washing Lon SL. City/State Stockton,CA Zip 95203 APN * ww Property Owner City of Stockton Address aas N. El Dorado Street, Ind Floor City/State Stockton, crip 95202 Phone (209) 937-8266 C-57 Contractor Cascade Drilling, L.P. Address 3000 Duluth Street City/State West Sac Chic 938110 Phone 916-638-1169 Consultant/Sub Cntr Bonkowski&AssocAddress 6400 Hollis St Suite 4 City/State Emeryville Lic Phone 510-450-0770 Billable Party Cascade Drilling, L.P. Address 3000 Duluth Street City/StateWest Sac CA Zip 95691 Phone 916-638-1169 GIS Coordinates:X 37, 7N_ Y —(2 (• 307 Wells to be installed in West Weber Street north of Site. CONSTRUCTION WORK TO BE PERFORMED: ® NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ❑SOIL BORING IDs ®WELLIDs BH-2014-1, BH-2014-2 ❑ OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS 4 in MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 8 ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS SCh 80 TYPE OF CASING: ❑STEEL IN PVC ❑ OTHER _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE _❑SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) _EI INJECTION(i.e.AirSDarge,Ozone)❑HAND AUGER GROUT SPECIFICATIONS Tvoe 1 Portland cement w/ 5% dry bentonite. _❑OTHER: OTHER: Sonic APPROX.BORING DEPTH 300 EI BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING❑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 ❑ 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 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulations a d all applicable-California laws. Signed ''-(� Title/Company General Manager/Cascade Drilling, L.P. Print Name Paul Snelgrove`J Date 07/24/2014 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESS WORK PLAN DATED - APPLICATION ACCEPTED BY Id K'cc ve", DATE IS '' EA GROUT INSPECTION BY FINAL INSPECTION BY 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# $ Qalc rvTz`Q -1 �)�� SR# 7U 3 l 30 /3a RO# (3500) �Qo 3qo fit° ( � 703/Z 900 C-57 ✓ WC WAIVER C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC EHD 29-01 5/09/12 WELL PERMIT APP