Laserfiche WebLink
. � V <br /> SAN JOAQUIN COUNTY u.E COP 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> SITE <br /> .' 600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br /> Telephone: (209)468-3449 Fax. (209)468-3433 Web:www.sjgov.org/ehd UNIT IV <br /> d <br /> WELL PERMIT APPLICATION co <br /> NON-REFUNDABLE NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 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 <br /> Joaquin County Development Title,chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> Assessor's <br /> Well Location 601 East Main Street Cross Street American City Stockton Zip 95202 Parcel# NA <br /> Property <br /> Owner City of Stockton Address 425 N. E1 Dorado Street City Stockton Zip 95202 Phone# (209) 937-8212 <br /> C-57 Contractor Advanced GeoEnvironmental Address fila Shaw Road City Stockton Zip 95215Lic# 600227 Phone <br /> ConsultanVSub Cntr same as above Address City Lic# Phone <br /> GIS Coordinates:X 37. 5 ,Y -1 u• ZS 3 ,Township Range Section <br /> WORK TO BE PERFORMED: <br /> ® NEW WELLIBORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER') ❑ DESTRUCTION(CHOOSE TYPE BELOW) <br /> ® SOIL BORING# B-1 and B-2 ❑OVER-BORE DIAMETER <br /> ❑WELL# ❑ PRESSURE GROUT <br /> ❑*OTHER GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 2 e ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA:_ <br /> ❑EXTRACTION ❑AIR HAMMER/DRIVEN CASING THICKNESS NA TYPE OF CASING:❑STEEL ❑PVC ❑ OTHER R <br /> ❑VAPOR ❑MUD ROTARY DEPTH OF GROUT SEAL -401 TREMIE TYPE TO BE USED IN AUGERS❑HOSE t <br /> ❑AIR SPARGE/OZONE ®PUSH POINT(GP OR CPT)GP GROUT SEAL PUMPED:®Yes ❑No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br /> ®SOIL BORING ❑HANDAUGER GROUT SPECIFICATIONS Portland Type 11 <br /> ❑OTHER: ❑OTHER: APPROX.BORING DEPTH -40' ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE <br /> CONDUCTOR CASING PROPOSED (N YES,list specifications in comment section) <br /> COMMENTS: Advancement of two borings to first ground water for collection of soil and ground water samples. Eoringm to be located in City RGW sidewalk <br /> immediately mouth of 601 East Main Street. <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS V <br /> I hereby certify that I have prepared this application and that the work will be done I accordance with San Joaquin County Ordinances,Rules and <br /> Regulatlons,aan all a pItc bl California Laws. <br /> Signed Title/Company Project Scientist/Advanced GeoEnvironmental <br /> Print Name Ally Colavita ; 4 <br /> c <br /> DEPARTMENT USE ONLY � LL-: W 35Z} <br /> SITE MAP IN UNIT IV FILE,ADDRESS: rOD� L 1 /(fes" :57KAI MAR 0 4 2009 <br /> WORK PLAN DATED: ` 'S'o9 rIA <br /> APPLICATION ACCEPTED BY DATE ISSUER• r'/lrnu-/� AREA�p <br /> GROUT INSPECTION BY FINAL INSPECTION BY CILA <br /> DESTRUCTION INSPECTION BY DATE <br /> COMMENTS/CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODE FEE INFO AMT RE ITTED CHECK# aRECV'D BY DATE PERMIT/SERVICE# INVOICE <br /> 35o a 513 315 Sly 3 y-o9 IAR#119301 <br /> C-57 t it WC -WAIVER C57 LETTER OF AUTHORIZATION T Ij[jITWYCROAC�JET{ _�Q SIT APP <br />