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2900 - Site Mitigation Program
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PR0542541
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Entry Properties
Last modified
6/11/2021 11:19:59 AM
Creation date
6/11/2021 10:57:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0542541
PE
2950
FACILITY_ID
FA0024463
FACILITY_NAME
ALL MINI VANS AND MINI TRUCKS AUTO DISMANTLER
STREET_NUMBER
930
Direction
E
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95206
APN
16718303
CURRENT_STATUS
01
SITE_LOCATION
930 E CHARTER WAY
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\dsedra
Tags
EHD - Public
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"pck Li kA4e-v1 Jr CO vli kr' - t--hoki\ <br /> <br />SANJOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />,otnecs grows he <br />oNO.0 SITE MITIGATION WELL & BORING PERMIT APPLICATION <br />For Wells and Borings Used for Contaminant Investigations and Remediation <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 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 />C qczo <br />Job Address 4:f.-3 0 EIS X- t CL-iiv ---t likia...A1 City/State/Zip 541 -4-7>V1 P <br />pl <br />\ t 7" Phone (5 10} (110 - <br />i <br />Cross Street A ut_ ie-7_? KA. S--h"e-e-"\-- . APN i /el- - I 0_3 - 0 c; '.--. I 5.-- „ 5-- 1 00 <br />.k(01-. 1- 15 1,51 --°.3, -41;3 —‘' Property Owner* Owner* Aft M l yl t VcA-vt5 ailot mmi tytAck.- Auit. Dichikh-ti <br />Address 6t -c). Ecot civlly-4---6( wooi • , ,, City/State/Zip ect-0 ,- te,i,y(cA eis_.,Z(0)2_(.04,—S-5511 <br />C-57 ContractorEV1 V i rp vqvt. eof1 (onli.vi 1 S0 c.,1 it, re,- License# &R,S--;7 7-0 / ' Phone 3I )6 ("0 <br />Address 30(I "T"CAJILev Rstms pvi ive <br />Consultant/Sub-Contractor .-pc.,_{=1-frteje- ST- <br />Address 1 011- '7,`g A‘ae--)Sk.t ti-e I 0 q- <br />(61 41?) City/State/Zip Ap46,,c/...-A 7560 3 <br />License# Phone (5-1 0 ) (// <br />City/State/Zip C4 74(0(7.P <br />TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />MONITORING 0 HOLLOW STEM BORING DEPTH 2. 4-0 40 n BOLTED TRAFFIC BOX 0 STOVE PIPE <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/VVells Require Access Agreements or Encroachment Permits <br />kc10 <br />EXTRACTION (Vapor/Water) <br />pt SOIL VAPOR PROBE <br />14 SOIL BORING <br />0 INJECTION (Air Soarae, Omni <br />OTHER <br />WELU SOIL BORING IDs <br />HAMMER/DRIVEN DIA. OF BOREHOLE <br />MUD ROTARY CASING THICKNESS <br />PUSH POINT (GP/ CPT) CONDUCTOR CASING 0 Yes 0 No <br />HAND AUGER GROUT SEAL DEPTH <br />OTHER: totSROUT SEAL PUMPED? 0,Yes 0 No <br />EI Oi I; 3 6 LI, r4 s" GROUT SPECIFICATIONS <br />I 4/ <br />MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA <br />TYPE OF CASING: 0 STEEL 0 PVC 0 OTHER <br />Boring Dia: Casing Dia: Casing Depth: <br />TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE 0 PIPE <br />(Note: Maximum Freefall Depth is 30 Ft) <br />DESTRUCTION WORK TO BE PERFORMED: <br /># WELLS TO BE DESTROYED ) -2- <br />WELL IDs -1-7) <br />GROUT SPECIFICATIONS <br />TREMIE TYPE TO BE USED 0 AUGERS 0 HOSE 0 PIPE <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br />Z. 0 OVER-BORE DIAMETER of inches to depth of <br />/ 0 PRESSURE GROUT To depth of feet below surface <br />/ 0 EXPLOSIVES From to feet below surface <br />/ 0 MUSHROOM CAP, 0 3 feet below surface or feet below surface if >3 feet <br />feet <br />COMMENTS: 4?, ; Z 10 0 r S fo 40 ft- 61s ta.,„„d. Le 4a.. <br />S (..,1I cces, 4.1",,„44 .oI f VA() Secwk 0 .1 <br />I hbreby certify that I am authorized tb 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 -r)„,Jt-,—,/-1, Title/Company i2c-,--C 41!\-erE-'v\-911v\‹..e..4\( 0,v1J > C ( 6 kC.P...-- s <br />Print Name /•) M GtivV51,-• Date / 113 ‘\ <br /> <br />DEPARTMENT USE ONLY N <br />Date Issued: \ Application Accepted By: <br />Grout Inspection By/Dates: <br /> <br />Destruction Inspection By/Dates: <br />Facility/Site Information <br /> <br />FA Name <br />/ <br />FA Address FA# <br />\ \ <br />c 7-c -t zyq k l <br />FA PE <br />.--)--cA CO <br />WP Reviewed By ',I' <br />Work Plan Date )....1 1 M <br />0 C-57 0 C-57 Authorization hit Other to Sign Permit 0 Worker's Comp 0 Workers Comp Waiver 0 Encroachment Permit 0 Access Agreement 0 Lead Agency Approval atiFR <br />COMMENTS/CONDITIONS: / <br />WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICES <br />Permit $152x <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />EHD 29-01 08-01-17 Site Mtigation Well Permit Application <br />*10i 514 3 tiYia-sg(4,5 - LI Pt, 2_ <br /><3.1c1C3 71,
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