Laserfiche WebLink
SAN JOAQUIN COUNTY <br /> r i ENVIRONMENTAL HEALTH DEPARTMENT SITE <br /> a, K 600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br /> p. Telephone: (209)468-3454 Fax:(209)468-3433 Web:www.sigov.org/ehd UNIT IV <br /> WELL PERMIT APPLICATION <br /> 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 Tille,chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> Well Location 2947 Navy Drive Cross Street W. Washington St. Stockton 95206 Assessor's <br /> g city Zip Parcel# 145-030-09/10 <br /> Property Port of Stockton <br /> Owner Address 2201 W. Washington St. City Stockton Zip 95203-z94Zphone#209-946-0246 <br /> C-57 Contractor Boart Longyear Address 3894 Railroad Ave. City Yuba City Zip 95991 Uc# 694686 Phone <br /> Consultant/SubCntrARCADIS Address S1411t03RockyRidgeDr. City Roseville Dc# Phone 916-786-6&54 <br /> GIS Coordinates:X 37.941644 ,Y 121.33L6�3 30 ,Township Range Section 3 i <br /> WORK TO BE PERFORMED: <br /> El NEW WELUBORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER-) ❑DESTRUCTION(CHOOSE TYPE BELOW) <br /> ❑SOIL BORING# ❑OVER-BORE DIAMETER <br /> ®WELL# SP/M-9 B,S P M-9C ❑PRESSURE GROUT <br /> ❑'OTHER GROUT SPECIFICATIONS <br /> ❑EXPLOSIVES DETONATING CARD <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ®MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 7" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: 2" <br /> ❑EXTRACTION ❑AIR HAMMER/DRIVEN CASING THICKNESS SCh 40 TYPE OF CASING:❑STEEL ®PVC ❑ OTHER <br /> ❑VAPOR ❑MUD ROTARY DEPTH OF GROUT SEAL 60 ft + TREMIE TYPE TO BE USED❑AUGERS®HOSE <br /> ❑AIR SPARGE/OZONE ❑PUSH POINT(GP OR CPr)_GROUT SEAL PUMPED:61 Yes ❑No (NOTE:MAXIMUM FREE-FALL DEPTH IS 30') <br /> ❑SOIL BORING CI HAND AUGER GROUT SPECIFICATIONS Neat Cement Grout <br /> ❑'OTHER: 129 OTHER: Sonic APPROX.BORING DEPTH 70-90 ft ®BOLTED TRAFFIC BOX OR ❑STOVE PIPE <br /> COMMENTS: CONDUCTOR CASING PROPOSED pr Yes,list spetlbouons In c nn.isecuon) <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS <br /> 1 hereby certify that I have prepared this application and that the workwill be done I accordance with San Joaquin County Ordinances,Rules and <br /> Regulations,and all applicable California Laws. <br /> Signed Title/Company Project Geologist-ARCADIS <br /> Print Name Jeremy Hughes <br /> Date <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS::: 9 -(/-J -YL� <br /> WORK PLAN DATED: -r Z O <br /> APPLICATION ACCEPTED BY DATE ISSUED �O/Jl�f /0 AREA <br /> GROUT INSPECTION BY���-�� FINAL INSPECTION BY DATE 10 <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 PERMIT/SERVICE# INVOICE <br /> 1 9- lj�Fo727 n <br /> SRR 402o <br /> C-57 WC -WAIVER C57 LETTER OF AUTHORIZATION TO SIGN PE IT ENCROACHMENT DOC <br /> EHD 2M1 10/26/09 .. <br /> r, WELL PERMIT APP <br /> �ie <br /> 6&127F <br />