SR0071308 - Laserfiche WebLink

Home Browse Search

'�"I�� SAN JOAQUIN COUNTY NSl ENVIRONMENTAL HEALTH DEPARTMENT CRIGNAL 1868 Hazelton Avenue, Stockton, CA 95205-6232 �01tj Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: www.siclov.org/eh - ��jj ' WELL & BORING PERMIT APPLICATION j%Aj3jA% j FELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION f C �s` 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. City of Stockton Right-of-way on Phelps and Spring Streets Site Location ,Z l 2.Z S, 4P.PdRT NO/ross Street 8th Street and Phelps Street City/State Stockton Zip 952o6 APN N/A Roo Property Owner City of Stockton Address 345 N. E1 Dorado Street City/State Stockton Zip 95202 Phone 209-937-8444 LOP SITE MITIGATION UNIT IV C-57 Contractor Woodward Drilling Address 550 River Road Advanced GeoEnvironmental Inc. 837 Shaw Road Consultant/Sub Cntr Address Billable Party Advanced GeoEnvironmental IncAddress 137 Shaw Road GIS Coordinates:X 37. 13223 Y '12r. 2,6SQ9 City/State Rio vista LiC 710075 Phone 707-374-4300 City/State Stockton LiC 680227 Phone 209-467-1006 Stockton 95215 209-467-1006 City/State Zip Phone CONSTRUCTION WORK TO BE PERFORMED: AID # R NEW WELL/BORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER) ❑ SOIL BORING IDs FEE INFO 0 WELL IDs MW -12, MW -13, MW -14, MW -15, MW -16, M111-17 CHECK # ❑ OTHER IDs DATE TYPE & # OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS -0 MONITORING E) HOLLOW STEM DIA OF BOREHOLE "'❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA: _❑ EXTRACTION Vapor/ Water ❑ HAMMER/DRIVEN CASING THICKNESS 0.154 TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER ❑ SOIL VAPOR PROBE ❑ MUD ROTARY DEPTH OF GROUT SEAL zs and 45 TREMIE TYPE TO BE USED: ❑ AUGERS © HOSE Q PIPE _❑ SOIL BORING ❑ PUSH POINT (GP/ CPT) GROUT SEAL PUMPED: ❑ Yes ❑ No (MAXIMUM FREE FALL DEPTH IS 30 FT) ❑ INJECTION (ie Air Sparge Ozone) 171 HAND AUGER GROUT SPECIFICATIONS Portland Cement t6 gallons of water per 94 lb bag; ❑ OTHER: ❑ OTHER: APPROX. BORING DEPTH 50 and 60 feet bsg ❑ BOLTED TRAFFIC BOX OR ❑ STOVE PIPE CONDUCTOR CASING ❑ No ❑ Yes: Casing Dia: Casing Depth Boring Dia: see attached Regional water Quality Control Board regulatory directive letter 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 (>3 FT) FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify th have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulations, an0all p cable lifo is laws. s Signed Title/Company Project Geologist/AGE Print Name niel Villanueva Date DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE - SITE ADDRESS A / 2 Z S, /al2'14>Q7-G(J�SI WORK PLAN DATED.1unil- 2L4. 2'eJ 14 APPLICATION ACCEPTED BY _ GROUT INSPECTION BY DESTRUCTION INSPECTION BY COMMENTS/CONDITIONS: 7FAW DATE FINAL INSPECTION BY DATE ACCOUNTING ONLY: AID # FAC # PE CODES FEE INFO AMT REMITTED CHECK # RECV'D BY DATE SERVICE REQUEST RO # PR # INVOICE oZc1U / $130x u 20l a lg Cr�a SR#(3500) PR # (2900) C-57 / WC (/ WAIVER kv a C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT IENCROACHMENT DOC L EHD 29-01 7/24/14 WELL PERMIT APP