SR0071311 - Laserfiche WebLink

Home Browse Search

Rqutk� SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT CRIGINA111- LOP 15 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION • `�R' N" •JAN �eephone�.09) 468-3147 Fax: (209) 468-3433 Web: www.sigov.org/eh UNIT IV \IFp_ti� �A " - � E V�,,oN��SS`�l LL & BORING PERMIT APPLICATION wwiiLL'S 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 140 West Harding Way Cross Street North Pacific Avenue City/State Stockton Zip 95204 APN 137-070-53 Property AID # ❑ NEW WELUBORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER) © SOIL BORING IDs -1 through VP -5 FEE INFO ❑ WELL IDs Owner Farouk Diab Address 10608 Oakwilde Avenue City/State Stockton Zip 95212 Phone 209-931-1044 Advanced GeoEnvironmental C-57 Contractor In address 837 Road 837 Shaw Stkt City/State ocon 680227 Lic Phone 209-467-1006 Advanced GeoEnvironmental Consultant/Sub Cntr inc Address 837 Shaw Road Stockton City/State 680227 Lic 209-467-1006 Phone . Advanced GeoEnvironmental IncAddress Billable Party B37 Shaw Road Stockton City/State 95215 Zip 209-467-1006 Phone GIS Coordinates: X 57'/VZ( Y i 2 L ,,Q %7? CONSTRUCTION WORK TO BE PERFORMED: AID # ❑ NEW WELUBORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER) © SOIL BORING IDs -1 through VP -5 FEE INFO ❑ WELL IDs CHECK # ❑ OTHER IDs DATE TYPE & # OF WELUBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM DIA. OF BOREHOLE 1. zs ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA: _❑ EXTRACTION Vapor/ Water ❑ HAMMER/DRIVEN CASING THICKNESS N/A TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER El SOIL VAPOR PROBE ❑ MUD ROTARY DEPTH OF GROUT SEAL 5 ' and 1"' TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE _❑ SOIL BORING El PUSH POINT (GP/ CPT) GROUT SEAL PUMPED: ❑ Yes ❑ No (MAXIMUM FREE FALL DEPTH IS 30 FT) _❑ INJECTION (i.e.AirSparge, Ozone )❑ HAND AUGER GROUT SPECIFICATIONS Portland cement 6 gallons of water per 94 lb bag ❑ OTHER: ❑ OTHER: APPROX. BORING DEPTH 56 and 10 ❑ BOLTED TRAFFIC BOX OR ❑ STOVE PIPE CONDUCTOR CASING ❑ No ❑ Yes: Casing Dia: Casing Depth: Boring Dia COMMENTS: RO # 3500) NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: # OF WELL(S) TO BE DESTROYED WELL IDs: GROUT SPECIFICATIONS TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE COMMENTS DESTRUCTION METHOD: (CHECK ALL THAT APPLY) ❑ OVER -BORE DIAMETER of INCHES TO DEPTH OF FT ❑ PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE ❑ EXPLOSIVES FROM TO FT BELOW SURFACE ❑ MUSHROOM CAP AT (>3 FT) FT BELOW SURFACE 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby ce at I ha prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulatio , an all a ica Calif" Signed Title/Company Project Geologist Print Na °v'. " d°Le''a Date "1/05/2014 L, DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE - SITE ADDRESS l L U 6L), �4rq P-DIAkY /t)19 -H S jrOCrK R -yo WORK PLAN DATED 1 4 N it al" •.0 APPLICATION ACCEPTED BY tic)'9-tk't GROUT INSPECTION BY DESTRUCTION INSPECTION BY COMMENTS/CONDITIONS: DATE FINAL INSPECTION BY DATE /' ZZ /ti ACCOUNTING ONLY: AID # FAC # PE CODES FEE INFO AMT REMITTED CHECK # RECV'D BY DATE SERVICE REQUEST RO # PR # INVOICE p a lv5 $130x CD `l U �vti1v ��-/5 SR# 2,2�o J 3ct� RO # 3500) PR # (2900) C-57 ✓ WC i/ WAIVER —lam C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ri ENCROACHMENT DOC—A-1 /f EHD 29-01 7/24/14 WELL PERMIT APP