SR0071437 - Laserfiche WebLink

Home Browse Search

ORIGINAL SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT LOP 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: www.siaov.ora/eh UNIT IV WELL & BORING PERMIT APPLICATION FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 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 Standards of the San Joaquin County Environmental Health Department. Site Location 666 West Weber Avenue _ Cross Street North Lincoln Street _ City/State Stockton, CA Zip_95202 _ APN 137-370-02 Property 22 East OwnStockton ROA _ Address Avenue Weir City/State Stockton, CA Zip -95203 — phone (209) 937 8811 C-57 Contractor Gregg Drilling & Testing _ Address .1950 Howe Rd. City/State Martinez, CA LIC 485165 — Phone (925) 313-5800 Consultant/Sub Cntstantec Consulting Services, Inc. idreSS 3017 Kilgore Rd. Suite 100 City/State Rancho LIC Phone. (916) 861-0400 Cordova, CA Billable Party Address City/State Zip Phone GIS Coordinates: X 3 7, 5715/ Y. t 7, J' CONSTRUCTION WORK TO BE PERFORMED: X NEW WELL/BORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER) ❑ SOIL BORING IDs X B WELL IDs OTHER IDs -Soil Vapor Probes:UPSV-7and UPSV-8. TYPE & # OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑ MONITORING ❑ HOLLOW STEM DIA. OF BOREHOLE 3 -"ch _ ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA: ❑ EXTRACTION: Vapor/ Water ❑ HAMMER/DRIVEN CASING THICKNESS 0.25 -inch diameter _TYPE OF CASING: ❑ STEEL ❑ PVC Rx OTHER Tenon _ SOIL VAPOR PROBE ❑ MUD ROTARY DEPTH OF GROUT SEAL -1 a. bgs _TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE _❑ SOIL BORING ❑ PUSH POINT (GP/ CPT) GROUT SEAL PUMPED: ❑ Yes ❑ No (MAXIMUM FREE FALL DEPTH IS 30 FT) _❑ INJECTION (i.e.AirSoaroe.Ozone) HAND AUGER GROUT SPECIFICATIONS _ Not Applicable _❑ OTHER: El OTHER: APPROX. BORING DEPTH _5-6 ftbgs II BOLTED TRAFFIC BOX OR ❑ STOVE PIPE CONDUCTOR CASING H No ❑ Yes: Casing Dia: Casing Depth: Boring Dia: NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) # OF WELLS) TO BE DESTROYED ❑ OVER -BORE DIAMETER OF INCHES TO DEPTH OF FT WELL IDs: ❑ PRESSURE GROUT To DEPTH of FT BELOW SURFACE GROUT SPECIFICATIONS ❑ EXPLOSIVES FROM To FT BELOW SURFACE TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE ❑ MUSHROOM CAP AT L3 FT) FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulations, and all applicable California laws. Associate Scientist, Stantec Consulting services, Inc. Signed 6-.y'4t- Title/Company Print Name Y y" SITE MAP IN UNIT IV FILE - SITE ADDRESS WORK PLAN DATED 04 if -vi r: APPLICATION ACCEPTED BY GROUT INSPECTION BY DESTRUCTION INSPECTION BY COMMENTS/CONDITIONS: DATE FINAL INSPECTION BY DATE l/ 1/22/15 ACCOUNTING ONLY: AID # FAC # PE CODES FEE INFO AMT REMITTED CHECK # RECV'D BY DATE SERVICE REQUEST I RO # #-7 INVOICE ',i53 �{�v QCJLtAJPi�^Z(,•IS cPPRR � ,?Ro5 $130x r SR# ! 7 !/ 3 6 03 (300 PR # 2900 C-57 ✓ WC 11" WAIVER L44-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ` ENCROACHMENT DOC &!f — EHD 29-01 7/24/14 WELL PERMIT APP