CORRESPONDENCE_2018-2019 - Laserfiche WebLink

Home Browse Search

ft, m..SHAUN Environmental Health Department e0u NTY 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 -6484 N Waverly Rd City/state)Zip Li n d P t^A 099-16 Phone R R 7- 3 9 r A Cross street - APN 09344002 Property Owner* c Tr PWD Solid Waste Phone 468-3066 Address 1820 E.• Hazelton Ave. city/state/zlp Stockton/CA/95205 C-57Contractorf�egg Drilling-' - License# 485165 Phone 925-313-5800 Address950 Howe Rd citytstate/zip Martinez/CA/9455.3 ConsultantlSub-Contractor CB& I License# LGH007 Phone 9 2 S - ? R R - -38 Address 4005 Portchicago Hwy city/state/zip Concord/CA/94520 CONSTRUCTION WORK TO BE: PERFORMED. *Nate: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPEOFWELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS IX MONITORING ❑HOLLOW STEM BORING DEPTH Ft . ❑ BOLTED TRAFFIC BOX 91 STOVEPIPE J/ ❑ EXTRACTION (VaporMlater) ❑ HAMMERIDRIVEN DIA OF BOREHOLE 10 C G . CI MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA 2 . 5 ❑ SOILVAPOR PROBE MUD ROTARY CASING THICKNESS SCh 8 0 TYPE OF CASING- ❑ STEEL ® PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT (GP/ CI?'t) CONDUCTOR CASING 11 Yes [] No Boring Dia: Casmg Dia: Casing Depth: ❑ INJECTION fAfrsnarae. ozone) ❑ HAND AUGER GROUT SEAL DEPTH .)L / 4? FT TREMIE TYPE TO BE USED: KI AUGERS ❑.HOSE ❑ PIPE ❑ OTHEROTHER-SoniC GROUT SEAL PUMPED? IA Yes [3No (Note: Ma)dmum Freefall Depth Is 30 Ft) WEI.USOILBORINGIDs _ , GRourSPECIFiCAmoNsNeat cement DESTRUCTION WORKTO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALLTHATAPPLY) # 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 El PIPE MUSHROOM CAP ❑ 3 feet below.surface or feet below sirboe If>3 feet r OMMENTS: MW -4A is located north of the landfill. - is locatedsoutheast of the landfill. -�=-=Y-tltiifbg�Teit{Ljr tti�T7; 8�i1'.�ulnori.Zerlio Col�I�76iS•lnS m1�7�icaa�unZu�,ccuta►r,cw.,,n ..,,-u ,OrdiMsid�11hof�niag a�o Signeay-._. -' - Title/Company San Joaquin County -Solid Waste Print Name Tai M. Bahadori Date Application Accepted By. I'V t-7 Grofit Inspection By/Dates: r_/i Destruction Inspection By/Dates: _ DEPARTMENT USE ONLY �ir�3s ; 'p-i"A-'O'� Date Issued: Sl .�u .c3 r� j fir/, �-rq, /( FA Name I I FA Address FA PE I I WP Reviewed By FA# Work Plan Date PR# ❑ C-57 ❑ e -5l Authors ation for Olherto Sign Permit ❑ worker's Comp ❑ Worker's Comp Waiver ❑ EnaaadWnt Permit ❑ Access Agreement ❑ Lead Agency Approval ❑ MFR 1�. r �C�p► - 3•, t/' Gama, IP TYPE ' PE 8C. FEE INFO R REMITT1 f) CHECK# RECV'D EiY dA WELL Permit yy7/ 3 / $152 x /�2 —�'rf .....n - .. ..-_u_._ e-.-.--.- , ni_ _,.t_- i', _ter_.....0.. nrnnG I •r •inn Aro UA -fn I C onn ACA MUG 1 ..�.nu n,nnhri nnm