Laserfiche WebLink
yo a�ln, co San Joaquin County. �I L� COPY 2 `y Environmental Health Department MAR 17 20O SITE <br /> 304 East Weber Avenue,3rd Floor,Stockton, CA 9WARUNMENT HEAl1GIITIGATION <br /> (209) 468-3449 Fax: (209) 468-3433 Web: www.co.san joaquirp " cTj5ERVICES UNIT IV <br /> /PoR <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 Title,Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br /> 115 Acre Parcel 500ft West of Assessors <br /> WELL LocalionLammers Rd/ValpiccOross street Valpico city Tracy ip95377 Parcel#209-240-26,27 <br /> PROPERTY PA ` <br /> Owner Russell lagehiro Address7200 W. 11th St. cityTracy zip95377 Phone#209-835-9491 <br /> o-57ContraaorPrecisionSamolinMddress1400 S.50th St. citAjQhmDjjaiQ4804L1c#6,3b3g,Phone#Rnn-671-4744 <br /> Consultant/gwvmfitrKennedy/Jenks Address622 Folsom St. city SF LIc#N/A Phone# 415-243-2150 <br /> GIS Coordinates:X ,Y ,Township 2S Range 4E Section 36 <br /> WORK TO BE PERFORMED: <br /> M NEW WELL/BORING FT,eEBPOA HYDROPUNCH,i!A fig A/6ER-PFFIt�t') p DESTRUCTION (choose type below) <br /> gSOIL BORING# tJ— 0 OVER-BORE. DIAMETER <br /> O WELL# 11 PRESSURE GROUT <br /> 0.Other GROUT SPECIFICATIONS <br /> COMMENTS: <br /> TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> 0 MONITORING 0 HOLLOW STEM DIA.OF BOREHOLE2in. 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA:___ <br /> a EXTRACTION aAIR HAMMER/DRIVEN CASINGTHICKNESS n/a TYPEOFCASING: pSTEEL pPVC OOTHER: <br /> 0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL TD TREMIE TYPE TO BE USED: []AUGERS �F196E itWE <br /> 0 AIR SPARGE)OZONE %S PUSH POINT(GP or CPT)GROUT SEAL PUMPED: 7()Yes p No (NOTE: MAXIMUM FREE-FALL DEPTH S 30') <br /> SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS neat cement <br /> 0 OTHER: 0 OTHER APPROX.BORING DEPTH150 1 0 BOLTED TRAFFIC BOX or 0 STOVE PIPE <br /> CONDUCTOR CASING PROPOSED no (if YES,list specifications in comment section) <br /> COMMENTS: CPT grouted either w/ grout collar or Tremmie Pipe <br /> NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br /> 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Or ' ances, Rul�san Regulations, and all applicable California State Laws. <br /> Signedx r iC/ 25ie TINe/Company Geologist/ Kennedy/Jenks Consultants <br /> Print Name Michael L. McLeod R.G. Date 3/15/04 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE,ADDRESS: r 110_ !r//��d N <br /> WORK PLAN DATED: <br /> Application Accepted 8y Date Issued 3 Area <br /> Grout Inspection By a Date Final Inspection By Datey <br /> Destruction Inspection By Date <br /> COMMENTS/CONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEE INFO AMOUNTREMITTED CHECK# RECD BY DATE PERMIT/SERVICE REQUEST# INVOICE <br /> of 1313 G� 3-17 sR# 003 2�C� <br /> C-57_ WC=WAIVER_ C-57 Letter of Authorization to sign permit_Encroachment doc_ <br /> EHD 29-02-001 <br /> 91302002 <br />