COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

G3L�C�COMf�D SA NUJ 0AQ U IN JAN 0 2 2018 Environmental Health Department COUNTY ENVIRONMENT HEALTH `o��rFoa�'i Greatness grows here. 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 1744 West Hammer Lane City/State/Zip Stockton, CA 95209 Phone Cross Street Brentwood Drive APN 077-280-31 Property Owner' Sims-Grupe Management Corporation, Inc. Phone (209) 478 9200 Address 374 Lincoln Center City/State/zip Stockton, CA 95207 C-57 Contractor J&H Drilling Co., Inc. License# 740854 Phone (714) 994 0402 Address 7431 Walnut Avenue City/State/zip Buena Park, CA 90620 Consultant/Sub-Contractor E2C Remediation License# 855819 Phone (916) 782 8700 Address 1020 Winding Creek Road, Suite 110 City/State/Zip Roseville, CA 95678 CONSTRUCTION WORK TO BE PERFORMED:'Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS (�[MONITORING 00 HOLLOW STEM BORING DEPTH 40 ft ❑BOLTED TRAFFIC BOX ❑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.Sch, 40 TYPE-OF CASING: ❑STEEL 00 PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes lQ No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Sparge.Ozone) ❑ HAND AUGER GROUT SEAL DEPTH 16 ft TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE QQ PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes PQ No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs MW-1,MW-2, MW-3,MW-4 GROUT SPECIFICATIONS Neat-Cement Grout 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: 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 Principal Engineer/ E2C Remediaiton Print Name Aiguo Xu Date 12/29/2017 DEPARTMENT USE ONLY (' / ` X Application Accepted By: Date Issued:Tr Grout Inspection By/Dates: 74 11�i Destruction Inspection By/Dates: Facilit /Site Information !, FA Name P '�I�arA Gtee-'nt-/ FA Address 1��{ �� i r c� FA# 1",Z: •1 I PR# j)_S1(z%{g7y FA PE L� WP Reviewed By L --Y Work Plan Date \r l S ❑C-57 lftrG57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement Lead Agency Approval ISR COMMENTS/CONDITIONS: WP TYPE PE Sc FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit �U� �,i� $152x 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 08-01-17 Site Mitigation Well Permit Application