COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SANAD UIN Environmental Health Department 1 ..l 1 V 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 4 _ ince 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 Howland Road City/State/Zip Lathrop/CA/95023 Phone 209-858-2511 Cross Street APN 19818008 Property Owner' Phone Address City/State/Zip C-57 Contractor Gregg Drilling,Inc. License# 485165 Phone 925-313-5800 Address 950 Howe Road _ City/State/Zip Martinez,CA 94553 Cons ultantisub-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 WELUBORINGUN MBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS I$1 MONITORING 2 0 HOLLOW STEM BORING DEPTH Up to 300 It bgs ❑BOLTED TRAFFIC BOX Q STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 8" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA _ ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL❑PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Bonng Dia: Casing Dia: Casing Depth ❑ INJECTION(Au spaw.omnst ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ®PIPE ❑ OTHER ® OTHER: Soak GROUT SEAL PUMPED? El Yes❑No (Note:Maximum Freefall Depth is 30 Ft) WELIJ SOIL BORING IDs PW-43,PW-44 GROUT SPECIFICATIONS Type ll-V DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #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 ❑PIPE MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: 8 monitoring wells will be installed to a maximum depth of 300 ft bgs. See attached table with well specifications. I hereby certify that I am authorized to complete this application and that the work will be done In accordance with San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed Title/Company Geologist/Geosyntec Consultants,Inc. Print Name Garrett Thornton Date June 29,2018 { DEPARTMENT.USE ONLY C, Application Accepted By: --Date Issued Grout Inspection By/Dates: Destruction Inspection By/Dates: Facillt /Site Information FA Name A f k�' FAAddress �b I•7 }r,oV"A_ re FA# OL L PR# t7 FA PE �pi bs WP Reviewed By L Work Plan Date ❑C-57 -57 Aulhorizafion for Other to Sign Permit orket s Comp ❑Workees Comp Waiver ❑Encroachment Permil ❑Access Agreement EfLeacl Agency Approval Wtlffl COMMENTS/CONDITIONS: WP TYPE I PE I SC FEE INFO JAMT REmirrEDI CH=RECVDDATE WELL PERMIT# INVOICE# Permit �} 1 $152 x a 3v 93v' 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 08.01.17 Site Mitigation Well Permit Application 11JP X1401 57-3 �(3 j `��"� Itt`'t L liLfl$ S("d-1`13$