Laserfiche WebLink
*San Joaquin County <br />Environmental Health Depart j� <br />304 East Weber Avenue, 3rd Floor, Stockton, C�ti'7 V�h���r �i <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd�'�'J �Vl, <br />Well Permit Application MAY 1 5 2008 <br />SITE <br />MITIGATION <br />UNIT IV <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DA%'16 ENT HEALTH <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work d df j1i9� ((t� ion is made in compliance with San <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Q p`drtment. Al. o <br />SAN JOAQUIN COUNTY AREA 12 MUNICIPAL WELL #2 Assessors <br />WELL Location Cross Street Mokulumne City Thornton Zip CA Parcel# aL Olt' N TH00f*J 121�. <br />PROPERTY <br />Owner SAN JOAQUIN COUNTY UTILITIES Address City Zip Phone# (209) 468-3090 <br />C-57 Contractor Gregg Drilling Address 950 Howe Ave City MartinezZip94553 Lic#485165 Phone# 925-313-5800 <br />Consultant / Sub Cntr Advanced GeoEnvironmental Address 837 Shaw Rd. City Stockton LiC# 680227 Phone# 209-467-1006 <br />GIS Coordinates: X , Y , Township Range Section <br />WORK TO BE PERFORMED: <br />8 NEW WELL / BORING (CPT, GEOPROBE, HYDROPUN CH, HAND -AUGER, OTHER*) 0 DESTRUCTION (choose type below) <br />0 SOIL BORING # 0 OVER -BORE. DIAMETER <br />I WELL # MW -7 0 PRESSURE GROUT <br />0 *Other GROUT SPECIFICATIONS <br />COMMENTS: __ { <br />TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />a MONITORING 8 HOLLOW STEM DIA. OF BOREHOLE 8 " 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: 2 <br />0 EXTRACTION 0 AIR HAMMER/DRIVEN CASING THICKNESS SCHD 40 TYPE OF CASING: 0 STEEL ff PVC 0 OTHER: <br />0 VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL 4' TREMIE TYPE TO BE USED: ff AUGERS 0 HOSE <br />0 AIR SPARGE/ OZONE 0 PUSH POINT (GP or CPT)GROUT SEA6fr WE iQlYNg 0 No (NOTE: MAXIMUM FREE -FALL DEPTH IS 30') <br />0 SOIL BORING 0 HAND AUGER GROUT SPECIFICATIONS Portland Type II <br />0 OTHER: 0 OTHER APPROX. BORING DEPTH 20' it BOLTED TRAFFIC BOX or 0 STOVE PIPE <br />CONDUCTOR CASING PROPOSED NA (if YES, list specifications in comment section) <br />COMMENTS: MW well is a monitoring well (2 "diameter, 4' grout, 20' total depth). <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />I hereby certify that I have preps d this application and that the work will be done in accordance with San Joaquin <br />Coury OyHinances, Rules an a ulation lllicable California State Laws. <br />( , <br />Print Name Lauren Cardinal l i Date._QA/22 / n e <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS:.* NO C "0 <br />WORK PLAN DATED: AA bl- C4 Z UD! E <br />Application Accepted By`` Date Issued Area <br />Grout Inspection By Date `r��;� Final Inspection By Date <br />Destruction Inspection By Date <br />COMMENTS / CONDITIONS' Co 6,-.4 Gl_ in W tM Ae C <br />ACCOUNTING ONLY: AID# FAC# <br />PE CODES <br />FEE INFO <br />AMOUNT REMITTED <br />CHECK # <br />REC'D BY <br />DATE PERMIT i SERVI.CE REQUEST # <br />4e_ =nCZ7— <br />INVOICE <br />�qv/ <br />89 <br />8 <br />759& <br />S i SR# <br />C-57 =_ WCWAIVER_ C-57 Letter of Authorization to sign permit%oael4rpert-dv� <br />EHD 29-02-001 <br />6/22/04 <br />