COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SAN 10 A Q U I N Environmental Health Department SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings Used for Contaminant Investigations and Remediation NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 48 Hours Advance Notice Required For All Inspections 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 Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. Job Address 1909 E Louise Ave City/State/Zip Lathrop/CA/95330 Phone 209-858-4125 Cross Street McKinley Rd APN 198100100000 Property Owner, 342 Sycanda LLC Phone 209-858-4125 Address 3515 Yosemite Ave Clty/State/Zip Lathrop/CA/95330 C-57 Contractor Yellow Jacket Drilling Service,LLC License# 1034407 Phone 909-989-8563 Address 9460 Lucas Ranch Road City/State/Zip Rancho Cucamonga,CA 91730 Consultant/Sub-Contractor Geosyntec Consultants,Inc. License# Phone 916-637-8334 Address 3043 Gold Canal Dr. City/State/Zip Rancho Cordova,CA 95670 CONSTRUCTION WORK TO BE PERFORMED:"Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS IN MONITORING 1 ❑ HOLLOW STEM BORING DEPTH Up to 300 ft bQs ❑BOLTED TRAFFIC BOX [23 STOVE PIPE [I EXTRACTION(Vapor/Water) ❑ HAMMERMRIVEN DIA.OF BOREHOLE S' El MULTIPLE CASINGS[IMULTI-LEVELWELL CASING DIA 2 it ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: &KTEEL❑PVC ❑ OTHER O SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Baring Dia: Casing Dia: Casing Depth: ❑ INJECTION tosorae.Ow4l ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE In PIPE ❑ OTHER ® OTHER: Sonic GROUT SEAL PUMPED? ®Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs PW-39 GROUT SPECIFICATIONS Type ll-V DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLYI #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDs ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS HOSE 0 PIPE ❑MUSHROOM CAP 3 feet below surface or feet below surface if>3 feet COMMENTS: 1 monitoring well will be installed to a maximum depth of 300 k bgs. See attached table with well specifications. 1 hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Joa ui County Ordin odes and Standards,and all other applicable California laws. Signed Title/Company Professional/Geosyntec Consultants,Inc. Print Name Garrett Thornton Date November 5,2018 DEPARTMENT USE ONLY Application Accepted By: Date Issued: `� I I k Grout Inspection By/Dates: Destruction Inspection By/Dates: Facill1tv/Site Information FA Name ` �� FA Address k b'17-I y Fa FA# L -� •l PR# FA PE J WP Reviewed By 1 Work Plan Date ❑C-57 I,<G57 Authorization for Other to Sign Permit orkers Comp []Workers Comp waiver [encroachment Permit ❑Access Agreement [mad Agency Approval FR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY I DATE WELL PERMIT# INVOICE# Permit 2-�GI I � $152x I ISZ. I 113 I^—x II 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138^1 www.sjcehd.com EHB-01-1�L� , „�, T L f,� 1138 l' SI`t/'i� fG 31 Permit 2A()