Laserfiche WebLink
Phone City/State/Zip Stockton, Ca 801 Diamond St. Job Address <br />740 East Carnegie Drive Address <br />License# Phone 415-243-2150 Consultant/Sub-Contractor Kennedy/Jenks Cons. Inc. <br />Address 303 2nd St. Ste 300 South City/State/Zip San Francisco CA 94107 <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br />DESTRUCTION WORK TO BE PERFORMED: <br /># WELLS TO BE DESTROYED <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br />OVER-BORE DIAMETER of inches to depth of feet <br />TREMIE TYPE TO BE USED I=1 AUGERS El HOSE El PIPE <br />WELL IDs 1:1 PRESSURE GROUT To depth of feet below surface <br />GROUT SPECIFICATIONS I=1 EXPLOSIVES From to feet below surface <br />El MUSHROOM CAP 0 3 feet below surface or feet below surface if >3 feet <br />lc /7 2,Vo3 <br />EHD 29-01 10-26-2015 <br />00 77 ,S7 <br />Site Mitigation Well Permit Application <br />Cross Street E. Worth St. ApN 155-320-21 <br />Property Owner* BNSF Railway Phone 909-386-4081 <br />City/State/Zip San Bernadino, Ca <br />License# 938110 Phone 925-849-6970 <br />Address 1641 Challenge Dr. City/State/Zip Concord, CA <br />TYPE OF WELLJBORING <br />MONITORING <br />EXTRACTION (Vapor/Water) <br />SOIL VAPOR PROBE <br />X SOIL BORING <br />INJECTION (Air Some. Ozone) <br />OTHER <br />WELL/ SOIL BORING IDs <br />CONSTRUCTION SPECIFICATIONS <br />BORING DEPTH 50 0 BOLTED TRAFFIC BOX 0 STOVE PIPE <br />DIA. OF BOREHOLE 2-1/4 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA <br />CASING THICKNESS n/a TYPE OF CASING: 0 STEEL 0 PVC 0 OTHER <br />CONDUCTOR CASING 0 Yes 0 No Boring Dia: Casing Dia: Casing Depth: <br />GROUT SEAL DEPTH TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE X I PIPE <br />GROUT SEAL PUMPED? X Yes 0 No (Note: Maximum Freefall Depth is 30 Ft) <br />GROUT SPECIFICATIONS Neat Cement <br />NUMBER INSTALLATION TYPE <br /> 0 HOLLOW STEM <br /> 0 HAMMER/DRIVEN <br />MUD ROTARY <br />_14 _x PUSH POINT (GP/ CPT) <br /> 0 HAND AUGER <br />OTHER: <br />COMMENTS: <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 alifornia laws. <br />Signed /#2`1.-/-4,-,. /hr- Title/Company 6 • ' /`-'4 ( 4"-J <br />Print Name f1. L G d Date 315 7/ 7 <br />DEPARTMENT USE ONLY <br />Application Accepted By: — Date Issued: / 276 <br />Grout Inspection By/Dates: <br />Destruction Inspection By/Dates: <br />Facility/Site Information <br />FA Name / L ify _" ..77--- , _ FA Address A,/ s„_, FA# (, z_2 (I 2s — PR# 0,:;wsAizi, <br />FA PE <br />i <br />'7',C-D WP Reviewed By v------- Work Plan Date 3/3 0..6, <br />gency Approval CIIIVIR 57 0 C.-57 Authorization for Other to Sign Permit fa‘orker's Comp 0 Worker's Comp Waiver 0 Encroachment Permit 0 Access Agreement Er Lead <br />COMMENTS/CONDITIONS: <br />SR TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY IATE SERVICE REQUEST# INVOICE# <br />Permit 24 - 3 3 $139x -2-, <br />....," / 4 j 7 iii ci?-- MI' <br />.1 <br />f /0 '1 Q77 7Q <br />1.• ...Ner-**. , <br />( <br />... - : <br />SAN JOAQUIN COUNTY I <br />E4NVIRONMENTAL HEALTH DEPART iviNT <br />1868 Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sicehd.EWRONMENTAL HEALTH <br />T SITE MITIGATION WELL & BORING PERMIT APPLICATPIN /SERVICES <br />For Wells and Borings Used for Contaminant Investigations and Remediation <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. <br />This application is made in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. <br />RECE WED <br />MAY 08 2u17 <br />C-57 Contractor Cascade Drilling, LP