COMPLIANCE INFO_CASE 2 - Laserfiche WebLink

Home Browse Search

oA`�Ut� c SAN .10AQUIN COUNTY G�f / •'LSE •.o ENVIRONMENTAL HEALTH DEPARTMENT ` :'• 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION 9�/FpR N Telephone: (209) 468-3147 Fax: (209) 468-3433 Web:www.sigov.org/ehd UNIT IV WELL & BORING PERMIT APPLICATION �b FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION l NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 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 Standards of the San Joaquin County Environmental Health Department. Site Location 1404 West Weber Ave Cross Street W.Washington Street City/State Stockton/CA Zip 95203 APN 145-19-008 Property Owner. C.Ryan Voorhees Address 28082 Nichols Rd. City/State Galt/CA Zip 95632 Phone 209-329-5133 C-57 ContractoF''regg Drilling&Testing,Inc. Address 950 Howe Rd. City/State Martinez/CA Lic 485165 Phone 925-313-0302 Consultant/Sub Cntr GEI Consultants Inc. Address 2868 Prospect Park Dr.#400 City/State Rancho Cordovbc Phone 916-631-4500 GEI Consultants Inc. 2868 Pros ect Park Dc#400 �— Billable Party Address P City/State Rancho CordovZip Phone 916-631-4500 GIS Coordinates:X 121'18'42.43"W Y 37'57'1.53"N Ca CONSTRUCTION WORK TO BE PERFORMED: L Q NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) I° X❑ SOIL BORING IDs SPNB1,SPNBIs,SPN132,SPN132s,SPNB3,SPNB3s,SPNB4,SPNB4s,SBI,SB2,SB3 ❑WELL IDs ❑OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑ MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 1-2" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS NA TYPE OF CASING: []STEEL ❑PVC ❑ OTHER _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL <3 feet TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE 11 0 SOIL BORING EI PUSH POINT(GP/CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) _❑INJECTION(i.e.AirSparge.Ozone)❑HAND AUGER GROUT SPECIFICATIONS Neat Cement _❑OTHER: ❑OTHER: APPROX.BORING DEPTH 3-15' ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE COMMENTS: CONDUCTOR CASING❑No[IYes:Casing Dia: Casing Depth: Boring Dia: NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #OF WELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT WELL IDs: ❑ PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE GROUT SPECIFICATIONS ❑ EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED:❑AUGERS ❑ HOSE ❑ PIPE ❑ MUSHROOM CAP AT(>3 FT) FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED(AFTER-PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify that I have prepaM this applica•on and that the work will be done in cordance with San Joaquin County Ordinances, Rules and Regulation and all ap (•cable C li ornia law 6 Signed 5 a 6 017 —S7tle/Company S or Geologist-GEI Consultants Inc. Print Name Ryan Alward Date 4-9-13 DEPA:R ENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESSJC-&CR aE WORK PLAN DATED 2 L / APPLICATION ACCEPTED BB ,- DAT GROUT INSPECTION BY 7E7 ECTION B –. ' �� ngTE DESTRUCTION INSPECTION BY COMMENTS/CONDITIONS: d l3 I d"6'1 13 ACCOUNTING ONLY: AID# AC r's ) PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RD# INV ICE REQUEST f6#\ YUYS/ $125x I' X00 CC, E -fl-I SR# y 3 5 375 RO# (3500) PR# (2900) C-57 V WC ✓ WAIVER—� C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT 1/ ENCROACHMENT DOC EHD 29-01 5/09/12 WELL PERMIT APP