WORK PLANS - Laserfiche WebLink

Home Browse Search

PQ�I" SAN .JOAQUIN COUNTY FILE COP Y YQ'.�cr•So ENVIRONMENTAL HEALTH DEPARTMENT i LOP 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION Telephone: (209) 468-3147 Fax:(209) 468-3433 Web:www.!' ov.or /eh t D '4�LFOR � 14 q WELL & BORING PERMIT APPLICATION FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION,JUN L ZO1Z NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED �7p' HEALTH Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is madfI1`4e;yyup, Joaquin County Development Title,Chapter 9-1115.3, and the Standards of the San Joaquin County Environmental Health Department. 16 pERMITI S Site Location 3003 Navy Drive Cross Street W.Washington St. City/State Stockton,CA Zip 95206 ApN Illy- 6 2 0 -080 Property Owner Tesoro Companies Inc. Address 3450 South 344th Way City/State Auburn,WA Zip 98001 Phone 210-283-2000 C-57 Contractor WDC Exp&Wells —Address 9580 Co Road 93D City/State Zamora,CA Lic 283326 Phone 530-681-2010 Consultant/Sub Cntr Stantec Address 3017 Kilgore Rd,Ste 100 City/State Rancho Cordeya,CA Phone 916-861-0400 Billable Party Stantec Address 3017 Kilgore Rd,Ste 100 City/State Rancho Cord,CA 95670 phone 916-861-0400 GIS Coordinates:X y CONSTRUCTION WORK TO BE PERFORMED: NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ❑SOIL BORING IDs ❑WELL IDs TS/M - ❑OTHER IDs TYPE&#OF WELLIBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS —3 MONITORING 91 HOLLOW STEM DIA.OF BOREHOLE 8 ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: 4 _I]EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS sch 80 TYPE OF CASING: ❑STEEL IN PVC ❑ OTHER _I]SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL 80 TREMIE TYPE TO BE USED: CSAUGERS ❑HOSE ❑PIPE _O SOIL BORING ❑PUSH POINT(GPI CPT) GROUT SEAL PUMPED:❑Yes [I No(MAXIMUM FREE FALL DEPTH IS 30 FT) _I]INJECTION de A'rSoame Ozonel❑HAND AUGER GROUT SPECIFICATIONS _O OTHER: ❑OTHER: APPROX.BORING DEPTH 95 ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE COMMENTS: CONDUCTOR CASING INNo❑Yes:Casing Dia: Casing Depth: Boring Dia: NOTE: OFFSITE WELLS&BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: CHECKALLTHATAPPLv Varies by well _#OF WELLS)TO BE DESTROYED OVER-BORE DIAMETER OF to 12 INCHES TO DEPTH OF 17 to 14T WELL IDs: TS/MW-1D to TS/MW-4D,OS-1 to OS-17,OS-1B to OS-813 [I PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE GROUT SPECIFICATIONS Neat Cement ❑EXPLOSIVES FROM To FT BELOW SURFACE TREMIE TYPE TO BE USED: ®AUGERS O HOSE ®PIPE ElMUSHROOM CAP;T(-3 FT) COMMENTS FT BELOW SURFACE 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,and all ap Ilcable Cal'ornia laws. / Signed 'C all C Title/Company M d t" ! M Z1 S[.✓1(d 11 6 C O k 5I S Print Name as e�/ I.1 w o ( r, ! Date DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESS 4211V� L) WAS 141UC ,Td WORK PLAN DATED f'V1Ay 3/ ! Z�o/2 APPLICATION ACCEPTED BY J•yoA,cKr+-t DATE ISSUED AREA_�r[Cj GROUT INSPECTION BY FINAL INSPECTION BY DATE T DESTRUCTION INSPECTION BY DATE COM M ENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO# INVOICE REQUEST PR# $125x 3�so 3�oy9Z G-1Iz SR �O 10 L 2�^J�.j RO o 3 �9D 7j�� 37S Z PR# 2900 C-57 WC WAIVER C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC EHD 29-01 5/09/12 WELL PERMIT APP