FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

J"-�` SMJOAQUIN Environmental Health Department V / COUNTY Crentnesc ornwt her,,, 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 2050 East Freemont Street City/State/Zip Stockton CA 95205 Phone (209)612-5573 Cross Street N Laurel Street APN 153-130-030-000 Property Owner* Fremont Plaza Investments LP Phone (209)612-5573 Address 7015 Morton Court City/State/Zip Stockton CA 95219 C-57 Contractor AdvancedGeo, Inc. License# 1063765 Phone (209)467-1006 Address 837 Shaw Road City/State/Zip Stockton, CA 95215 Consultant/Sub-Contractor Slagle Drilling Corperation License# Phone (916) 363-9355 Address 11345 Trade Center Drive City/State/Zip Rancho Cordova, CA 95742 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/VVells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE ❑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 Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Sparge,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELV SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLYI #WELLS TO BE DESTROYED Three(3) ®OVER-BORE DIAMETER of 8.25 inches to depth of TD feet WELL IDs IW-1,IW-2,MW-23 ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Portland type II cement to surface grade ❑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: MW-23 is 55ft bsg. IW-1 and IW-2 are both 120ft bsg. 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 AdvancedGeo, Inc. Print Name Evan Schmidt Date 01/12/2021 DEPARTMENT USE ONLY Application Accepted By: Aaron Gooderham* Date Issued: January 13,2021 Grout Inspection By/Dates: Destruction Inspection By/Dates: ti ti� Facilit /Site Information r FA Name Apache Plastics FA Address 2050 Fremont Street FA# 25903 PR# FA PE WP Reviewed By Aaron Gooderham Work Plan Date 1/5/21\ ❑C-57 C-57 Authorization for Other to Sign Permit orker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ccess Agreement V#fread Agency Approval FR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2902 1 313 $152 x 3 $456.00 CARD AG 01/06/2020 WP0041613 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 Confirmation Number:118856661 Site Mitigation Well Permit Application