Laserfiche WebLink
SAN JOAQUIN <br /> <br />Environmental Health Department <br />--COUNTY— <br />Greatness grows here. <br />SITE MITIGATION WELL & BORING PERMIT APPLICATION <br />For Wells and Borings Used for Contaminant Investigations and Remediation <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 1624 East Alpine Avenue <br /> <br />City/State/Zip Stockton/CA/95204 Phone 510-938-7038 <br /> <br />Cross Street West Ln APN 117-080-06 <br />Property Owner* Pardeep Sooch <br /> <br />Phone 510-938-7038 <br />Address 1079 E. Yosemite Ave City/State/Zip Manteca, CA 95336 <br /> <br />C-57 Contractor Cascade Drilling <br />Address 3000 Duluth St. <br />License* 938110 Exp. 9/30/19 Phone <br />City/State/Zip W. Sacramento, CA 95691 <br />916-638-1169 <br />Consultant/Sub-Contractor Dudek License* Phone 760-479-4130 <br />Address 605 3rd Street City/State/Zip Encinitas/CA/92075 <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br />TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />MONITORING n HOLLOW STEM BORING DEPTH 57' 0 BOLTED TRAFFIC BOX o STOVE PIPE <br />EXTRACTION (VaporANater) 0 HAMMER/DRIVEN DIA, OF BOREHOLE 10 ' ID 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA <br />SOIL VAPOR PROBE 0 MUD ROTARY CASING THICKNESS NA TYPE OF CASING: 0 STEEL 0 PVC 0 OTHER <br />SOIL BORING 3 0 PUSH POINT (GP/ CPT) CONDUCTOR CASING Dyes KI No Boring Dia:Casing Dia: Casing Depth: <br />INJECTION *Seam Ozonot 0 HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE 0 PIPE <br />OTHER 0 OTHER: GROUT SEAL PUMPED? 0 Yes Ea No (Note: Maximum Freefall Depth is 30 Ft) <br />WELL/ SOIL BORING IDs B-la. 134b. B-lc GROUT SPECIFICATIONS <br />WELL IDs B-la, B-la. B-ic <br />GROUT SPECIFICATIONS Hydrated Bentonite Chios/Pellets <br />TREMIE TYPE TO BE USED 0 AUGERS 0 HOSE IN PIPE <br />DESTRUCTION METHOD: (CHECK AU. THAT APPLY) <br />iat OVER-BORE DIAMETER of 10 inches to depth of 57 feet <br />ui PRESSURE GROUT To depth of 57 feet below surface <br />D EXPLOSIVES From to feet below surface <br />0 MUSHROOM CAP 03feet below surface or feet below surface if >3 feet <br />DESTRUCTION WORK TO BE PERFORMED: <br /># WELLS TO BE DESTROYED 3 <br />COMMENTS: <br />I hereby certify that I am authorized to complete this application and that the work will be done In accordance with <br />an Joaquin County Ordinance Codes and Standards, and all other applicable California laws. <br />Title/Company Principal Engineer/Dudek <br />Date 04/23/2019 <br />Signed <br />Print Na <br />DEP RTMENT USE ONLY <br />Application Accepted By: <br /> <br />Date Issued: 5-! 2, / fr <br /> <br />/2- Grout Inspection By/Dates: ,d -51/ c'/7 <br /> <br />Destruction Inspection By/Dates: <br />FacIlity/Slte Information <br /> <br />FA Name P7 <br />TA2 r 1•44/1( •-r•ivr-AtAl <br />FA Address 1322.)-1 •i Al enu, 64/..-- FA# ooscztim PR# cos-ti 440 2 <br />FA PE ?Ace/ WP Reviewed By L ----)? Work Plan Date <br />t ( ?AAP\ <br />0 C-57 (a(57 Authorization for Other to Sign Permit Erforker's Comp 0 Worker's Comp Waiver 0 Encroachment Permit 0 Access Agreement 2<ad Agency Approval Prig-R <br />commFNTSICONDITIONS: G-ros•-ly ...2 V/4.4".. 4N.'44- . CV...44NA- Cr......./44 ' <br />_ .. <br />WP TYPE PE SC FEE INFO AMT REMITTED CHECK* RECV'D BY DATE WELL PERMIT* INVOICE* <br />Permit 2,10.5 3 1 - $152x 3 t 4,510 iostrIng L )( c 4,'1 (--) f0031S-ILi <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />EHD 29-01 08-01-17 Site Mitigation Well Permit Application