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2900 - Site Mitigation Program
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PR0538799
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COMPLIANCE INFO
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Last modified
2/10/2020 11:57:53 AM
Creation date
2/10/2020 11:07:14 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0538799
PE
2960
FACILITY_ID
FA0022276
FACILITY_NAME
UP WELDING FACILITY, LANDFILL AREAS, RRI
STREET_NUMBER
0
STREET_NAME
SHIPLEY
STREET_TYPE
RD
City
STOCKTON
Zip
95203
CURRENT_STATUS
01
SITE_LOCATION
SHIPLEY RD
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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D <br /> SAN JOAQUIN COUNTYon <br /> �. t•.o <br /> ENVIRONMENTAL HEALTH DEPARTMENT LOP <br /> N` { 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION <br /> P.. Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: www.sigov.orq/ehd UNIT IV <br /> -4�lFpR <br /> WELL & BORING PERMIT APPLICATION RECEIVED <br /> FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED APR 013-2014 <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is m� a wn cpEp1.p ' , <br /> Joaquin County Development Title,Chapter 9-1115.3,and the Standards of the San Joaquin County Environmental Health De,c+rvrnul_V,fMt !Nv_, <br /> X's /1� EALTH <br /> Site Location hlpley Road Cross Street Humphreys Dr City/State Stockton Zip 95203 P�RISEMA YES <br /> Property 209-946-0246 <br /> Owner Port of Stockton Address 2201 W.Washington St City/State Stockton Zip 95203 Phone <br /> C-57 Contractor Woodward Drilling Address 550 River Road City/State Rio Vista Lic #710079 Phone 707-374-4300 <br /> Consultant/Sub Cntr ERS Corp Address 1600 Riviera Ave Ste 310 City/State Walnut Creek Lic #879420 Phone_925-938-1600 <br /> Billable Party ERS Corp Address 1600 Riviera Ave Ste 310 City/State Walnut Creek Zip 94596 Phone 925-938-1600 <br /> GIS Coordinates:X 37.956562 Y -121.371508 <br /> 3?7cec s <br /> CONSTRUCTION WORK TO BE PERFORMED: <br /> ❑ NEW WELL/BORING(CPT,GEOPROSE,HYDROPUNCH,HAND-AUGER,OTHER) <br /> ❑ SOIL BORING IDs <br /> ❑WELL IDs <br /> ❑OTHER IDs <br /> TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: <br /> _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER <br /> _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE <br /> _❑SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) <br /> _❑INJECTION(i.e.Air Sparge,Ozonel❑HAND AUGER GROUT SPECIFICATIONS <br /> _❑OTHER: ❑OTHER: APPROX.BORING DEPTH ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE <br /> CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth: Boring Dia: <br /> COMMENTS: <br /> NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) <br /> 2 #OF WELL(S)TO BE DESTROYED W-240,-241,-056,-150,-039.-177,-184,-030,-152,-153 ❑ OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT <br /> WELL IDs: P-104,-113A,-1138,-119,-123,-128,-134,-139,-143,-112,-118, X❑ PRESSURE GROUT TO DEPTH OF 25 FT BELOW SURFACE <br /> GROUT SPECIFICATIONS neat cement ❑ EXPLOSIVES FROM TO FT BELOW SURFACE <br /> TREMIE TYPE TO BE USED: x❑AUGERS ❑ HOSE ❑ PIPE x❑ MUSHROOM CAP AT(>3 FT) 3 FT BELOW SURFACE <br /> COMMENTS Pressure grout and cap wells per County and RWQCB specifications.There is no environmental contamination at these wells <br /> 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS <br /> 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 <br /> Regulations nd all pppl• able California laws. <br /> Signed L 9 a��► �� Title/Company Project Scientist,ERS Corp <br /> Print Name Leslie Shields Date April 1,2014 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE-SITE ADDRESS a'3 Mboft_4(L - SN I PL'-' ROYQ <br /> WORK PLAN DATED -'/9 N U 4Q 9 S 1 201,4 <br /> APPLICATION ACCEPTED BY J.!ja 1pgykn� DATE ISSUED M- `/ AREA <br /> GROUT INSPECTION BY FINAL INSPECTION BY DATE <br /> DESTRUCTION INSPECTION BY DATE <br /> COMMENTS/CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO# INVOICE <br /> � <br /> +� �+ c' REQUEST( PR# <br /> /� <br /> 0"'l 0 a`- $ 125 x cS I .p.�td�V7�2 1 �`I�I SR# l Z <br /> v s 375- Ro# <br /> (3500) <br /> PR# <br /> (2900) <br /> C-57 ✓ WC �LWAIVER AJ C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT r/ ENCROACHMENT DOC / 44 <br /> EHD 29-01 5/09/12 WELL PERMIT APP <br />
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