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2900 - Site Mitigation Program
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PR0540782
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Entry Properties
Last modified
2/17/2026 2:36:45 PM
Creation date
2/6/2020 9:52:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
WORK PLANS
RECORD_ID
PR0540782
PE
2960 - RWQCB LEAD AGENCY CLEAN UP SITE
FACILITY_ID
FA0023314
FACILITY_NAME
RMB GARAGE
STREET_NUMBER
715
Direction
N
STREET_NAME
HUNTER
STREET_TYPE
ST
City
STOCKTON
Zip
95202
APN
13905409
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
715 N HUNTER ST STOCKTON 95202
Tags
EHD - Public
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SAN JOAQUIN Environmental Health Department <br /> LUUN I Y <br /> Greatness grows heft. <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> For Wells and Borings Used for Contaminant Investigations and Remedlation <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED - <br /> 48 Hours Advance Notice Required For All Inspections <br /> Application is hereby made to San Joaquin County for a permit to construct and/or Install the work described. <br /> This application is made in compliance with San Joaquin County Development Title, Chapter 9-1115.3,and the San Joaquin County Well Standards. <br /> Job Address 724 N. Hunter Street City/State/Zip Stockton, CA ry52o Z Phone 408-727-5553 <br /> Cross Street Hunter St. & Park Street APN 139-056-120 <br /> Property Owner`Sazzadul Khan Phone 408-727-5553 <br /> Address 3326 Arie Jos ua Ct City/State/Zip San Jose, CA 95135 <br /> C-57 contractor Advanced GeoEnvironmental, Inc. License# 680227 Phone 209-467-1006 <br /> Address 837 Shaw Road City/State/Zip Stockton, CA 95215 209-467-1006 <br /> Consultant/Sub-Contractor License# 680227 Phone <br /> Address 837 Shaw Road City/StatelZip Stockton, CA 95215 <br /> CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br /> TYPE OF WELDBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 6' INBOLTED TRAFFIC BOX ❑STOVEPIPE <br /> ❑ EXTRACTION(VapotMaler) ❑ HAMMERNRIVEN DNA.OF BOREHOLE _4'❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING IRA nab <br /> M SOILVAPOR PROBE ❑ MUD ROTARY CASINGTHICKNESS 0,25-INCHTYPEOFCASING: ❑STEEL ❑PVC M OTHER to 011 11 <br /> ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTORCASING ❑Yes [XNo Bodng Dia: na Casing DW. na Casing Depth: na <br /> ❑ INJECTION IAFsoame-ozone) X ❑ HANDAUGER GROUTSEALDEPTH 4' TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE <br /> ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? [I Yes WNo (Note:Maximum Freefag Depth is 30 Ft) <br /> WELD SOIL BORING IDs Sy 3 GROUT SPECIFICATIONS Portland Type 11 <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br /> #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER ofinches to depth of feet <br /> WELL IDs ❑PRESSUREGROUT To depth offeet below surface <br /> GROUT SPECIFICATIONS [I EXPLOSIVES From to_feet below surface <br /> TREMIE TYPE TO BE USED ❑AUGERS HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below surface or feel below surface if>3 feet <br /> COMMENTS: SEE RWQCB-APPROVED WORKPLAN DATED 06 JANUARY 2019 <br /> 1 hereby certify that I am authorized to complete this application and that the work will be done in accordance with <br /> San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. <br /> Signed 7 & Title/Company PROJECT MANAGER/A.G.E. <br /> Print Name TIMOTHIlt J. CUELLAR Date o8'3 n Z-01 g <br /> EPARTMENT USE ONLY <br /> Application Accepted By: Date jsssupued�:: (✓Jo 1 / <br /> Grout Inspection By/Dates: / W <br /> Destruction Inspection By/Dates: <br /> Faciltt /Site Information <br /> FA Name P-Mg FA Address +.NyttV_ FA# 0� Z33 It+, PR# oS Z <br /> FA PE �.rj (� P Reviewed By j�" v _ l4 Q r & ork Plan Date i 120 J� <br /> ❑C-57 ❑C-57 Authoriza9w for Other to Sign Permit ❑Wakens Gaup 0111otimes0ompWahYr ❑EnxoschmentPermil ❑Access Agreement ❑Lead Agency Approval ❑MFR <br /> COMMENTS/CONDITIONS: <br /> WP TYPE PE I SC I FEE INFO JAMT REMITTED I CHECK# I RECV'D BY D TE WELL PERMIT#Aye CE INVOI # <br /> Permit ZQb I f $152 x g� �0 g W Poo tt oo v <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD29-0109-01-17 5,/I Site Mitigation Well Permit Appliwibn <br />
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