Laserfiche WebLink
SAN JOAQUIN Environmental Healt1.1.11=1 <br />E. Worth <br />BNSF Railway <br />801 Diamond St. Job Address <br />Cross Street <br />Property Owner* <br />City/State/Zip Stockon, CA <br />APN 155-320-21 <br />City/State/Zip San Francisco CA 94107 Address 303 Second St. Ste 300 South <br />Date Issued: <br />COUNTY <br />MITIGATION WELL & BORING PERMIT APPLICA <br />Is and Borings Used for Contaminant Investigations and Reme <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />48 Hours Advance Notice Required For All Inspections <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work de <br />This application is made in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaq <br />4/41 <br />.,4,cr4,4 I T E <br />For Wel <br />441 <br />‘-‘ <br />Address 740 East Carnegie Dr. <br />C-57 Contractor <br />Address 3000 Duluth St. <br />Consultant/Sub-Contractor Kennedy/Jenks Consultants, Inc. <br />City/State/Zip San Bernardino, CA <br />License# 938110 <br />City/State/Zip West Sacramento, CA 95 <br />License* <br />Cascade Drilling LP <br />CONSTRUCTION WORK TO BE PERFORMED: "Note: Offsite BoringsNVells Require Access Agreements or Encroach <br />TYPE OF WELL/BORING <br />MONITORING <br />12 EXTRACTION (VaporMaler) <br />ID SOIL VAPOR PROBE <br />SOIL BORING <br />INJECTION Mit Soaroe.Ozotel <br />OTHER <br />WELL SOIL BORING IDs <br />NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> 0 HOLLOW STEM BORING DEPTH 50 1:11 BOLTED TRAFFIC BOX 0 ST <br /> [g] <br /> <br />HAMMER/DRIVEN DIA. OF BOREHOLE 2-inch 13 MULTIPLE CASINGS J MULTI-LEVEL WELL CASING DIA <br /> CI MUD ROTARY CASING THICKNESS TYPE OF CASING: 0 STEEL 0 PVC 0 OTHER <br />4 El PUSH POINT (GP/ CPT) CONDUCTOR CASING °Yes El No Boring Dia: Casing Dia: Casing Depth: <br /> 0 HAND AUGER GROUT SEAL DEPTH 50 TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE R] PIPE <br /> 0 OTHER - — GROUT SEAL PUMPED? El Yes 0 No (Note: Maximum Freef all Depth is 30 Ft) <br /> GROUT SPECIFICATIONS Neat Cement <br />I hereby certify that I am authorized to complete this application and that the work will be done in accordance with <br />San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. <br />Signed 1"/,‘ -•,irr Title/Company 604, <br />Print Name n AL'L.e e Date 11/2 6//f <br />USE ONLY <br />Application Accepted By: <br />Grout Inspection By/Dates: <br />Destruction Inspection By/Dates: <br />Facility/Site Information <br />i s3 <br />FA Name 60 PA Address /co i q>uvat a irmk ct- FA# 03.2.4,91.--- <br />FA PE <br />291,14/ 0 <br />WP Reviewed By I - )( Work Plan Date <br />PRtf <br />i.4 1 I i( <br />0 C-57 IEK-57 Authorization for Other to Sign Permit worker's Comp 0 Workers Comp Waiver 0 Encroachment Permit 0 Access Agreement riKad Agency Approval 12I<F; <br />COMMENTS/CONDITIONS: <br />WP TYPE PE SC FEE INFO AMT REMITTED CHECK* RECV'D BY DATE WELL PERMIT* INVOICE# <br />Permit 2;0;15 31) $152 x 3 44S% gsifi/i% L ,)( i,-tPno -Nal <br />1868 E. Hazelton Avenue I Stockton, California 96205 I T 209 468-3420 I F 209 464-0138 p www.sjcehd.com <br />2m4,3 s--23 ycz. )( 3 gcl 1-53 I t451, 1-4 END 29-01 08-01-17 Site Mitigation Well Permit Application <br />DESTRUCTION WORK TO BE PERFORMED: PESTRUCTION METHOD: (CHECK ALL THAT APPLY1 <br /># WELLS TO BE DESTROYED 0 OVER-BORE DIAMETER of inches to depth of feet <br />WELL Ds 0 PRESSURE GROUT To depth of feet below surface <br />GROUT SPECIFICATIONS 0 EXPLOSIVES From to feet below surface <br />TREMIE TYPE TO BE USED 0 AUGERS ci HOSE 0 PIPE ) CI MUSHROOM CAP 03 feet below surface or feet below surface If >3 feet <br />COMMENTS: