Laserfiche WebLink
` • SAN .JOAQUINCOUNTY • FILE COPY <br /> oPAt'lN-• <br /> ENVIRONMENTAL HEALTH DEPARTMENT LOP <br /> 600 East Main Street, Stockton, CA 95202-3029 SITE MITIGATION <br /> Telephone: (209) 468-3454 Fax: (209) 468-3433 Web: www.sigov.orq/Wh4 UNIT IV <br /> %FU <br /> WELL & BORING PERMIT APPLICATION E® <br /> FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIAT,IpM• O 7 2012 <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> �thS <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This applicatiojr�y,� I compliance with San <br /> Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health DEIffii__ .�`IMENTAL HEALTH <br /> PERMIT/� <br /> Site Location 502E Grant Line Rd. Cross Street MacArthur Dr. City Tracy Zip 95376 APN <br /> Property <br /> Owner PG&E Address 3401 Crow Canyon Rd. City San Ramon zip 94582 Phone 925-383-9517 <br /> C-57 Contractor Woodward Drilling Address 550 River Road City Rio Vista Lie 710079 Phone 707-374-4300 <br /> Consultant/Sub Cntr Parsons Address 2121 N.California Blvd. City Walnut Creek Lie __ Phone 925-941-3737 <br /> Billable Party Parsons Address 100 W.Walnut City Pasadena Zip 91124 Phone 626-440-6067 <br /> GIS Coordinates:X 3-2 ?Z( Ip Y l 21 . q l(o <br /> CONSTRUCTION WORK TO BE PERFORMED: <br /> IN NEW WELL/BORING(CPT,GEOPROBE.HYDROPUNCH,HAND-AUGER,OTHER) cn <br /> EN SOIL BORING IDs <br /> ❑WELL IDs <br /> ❑OTHER IDs <br /> TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS (11 <br /> _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 3 in ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: ^ <br /> _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS 0.25 in. TYPE OF CASING: ❑STEEL ❑PVC IN OTHER PTFE W , <br /> X❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL I -4 R.b9S TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE A <br /> ❑SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ®No(MAXIMUM FREE FALL DEPTH IS 30 FT) <br /> _❑INJECTION r e Air Soame Ozones N HAND AUGER GROUT SPECIFICATIONS Hydrated granular bentonite <br /> _❑OTHER: ❑OTHER: APPROX.BORING DEPTH 5.5 ft bgs KI BOLTED TRAFFIC BOX OR [ISTOVEPIPE <br /> CONDUCTOR CASING 6 No❑Yes:Casing Dia: Casing Depth: Boring Dia:_ <br /> T <br /> COMMENTS: <br /> NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS <br /> D TRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) <br /> #of W eu ❑OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT <br /> WELL IDs: NSA ❑PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE <br /> GROUT SPECIFICATIONS IVES FROM To FT BELOW SURFACE <br /> TREMIE TYPE TO BE USED:❑AUGERS ❑HOSE ❑PIPE ❑MUSHROO Fr BELOW SURFACE <br /> COMMENTS <br /> 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS <br /> I hereby certify that I have pr red th' application and that the work will be done in accordance with San Joaquin County Ordinances,Rules and <br /> RegulatirJrr9,aril alltic al' rn' Laws. <br /> Signed -IX�t.0-.n._ Title/Company Senior Geologist <br /> Print Name —Brian K. Eytt;Ifeson Date 2/6/12 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE SITE ADDRESS $OZ C • GQrt� I �r tiE <br /> WORK PLAN DATED <br /> APPLICATION ACCEPTED BY J Yo✓qK�w \ DATE IS ° � I r? -- AREA <br /> GROUT INSPECTION BY FINAL INSPECTION BY DATE2 <br /> DESTRUCTION INSPECTION BY \ DATE <br /> COMMENTS/CONDITIONS: /,N5't t- 41 (Qmt VMPdR PRaeE <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO# INVOICE <br /> REQUEST PR <br /> U I $ 125x! 12sR# 000y 22- <br /> (33500) <br /> 0-#0)52� S <br /> 67 WC WAIVER yVf$ — C57 LETTER OF AUTHORIZATION TO SIGN PERMIT i i ENCROACHMENT DOC N <br />