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WP0043689
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GRANT LINE
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2900 - Site Mitigation Program
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WP0043689
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Last modified
10/14/2022 4:21:39 PM
Creation date
10/14/2022 4:15:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
BILLING/PERMITS
RECORD_ID
WP0043689
PE
2905
FACILITY_ID
FA0027323
STREET_NUMBER
1651
Direction
E
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95304-
APN
21307041
ENTERED_DATE
8/29/2022 12:00:00 AM
SITE_LOCATION
1651 E GRANT LINE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\tsok
Tags
EHD - Public
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T <br />11 <br />SAN JUAQUIN <br />COUNTY <br />Greatness grows here. <br />Jeff Wong Inspector <br />Environmental Health Department <br />• 012F 9 • <br />NOWREFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />24 Hours Advance Notice Required For All Inspections <br />CALL (209) 953=7697 For INSPECTIONS <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. <br />This application is na de in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. <br />.. � .. �� .: �����■��ei'■1i�iRtiT7:Z.fTa <br />Cross Street North Chrisman Road <br />Property Owner* <br />City/State/Zip Tracy/CA/95304 <br />AP N 213-07-017 <br />August Marty and Marilyn Marty 2008 Revocable Trust <br />Address 2517 Summerfield Drive <br />C-57 Contractor Trinity Drilling, Inc. <br />Address 114 Fern Street <br />Consultant/Sub-Contractor Citadel EHS - Atten: Scott Grasse, PG <br />Address 1725 Victory Blvd. <br />City/State/Zip Stockton, CA 95209 <br />License# 1010926 <br />City/State/Zip Santa Cruz, CA 95060 <br />License# NA <br />City/State/Zip Glendale, CA 91201 <br />Phone NA <br />Phone <br />209.715.1425 <br />Phone 831.426.5607 <br />Phone 818.246.2702 <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br />TYPE OF WELLIBORING <br />❑ MONITORING <br />❑ EXTRACTION (Vapor/Water) <br />SOIL VAPOR PROBE <br />❑ SOILBORING <br />❑ INJECTION (Air Sparge, ozone) <br />❑ OTHER <br />WELL/ SOIL BORING IDs <br />NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />❑ HOLLOW STEM BORING DEPTH �30 feet ❑BOLTED TRAFFIC BOX ❑STOVE PIPE <br />❑ HAMMER/DRIVEN DIA. OF BOREHOLE 2.25" Geoprobe ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA <br />3 ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER <br />PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes ❑ No Boring Dia: Casing Dia: Casing Depth: <br />❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE <br />❑ OTHER: GROUT SEAL PUMPED? ❑ Yes ❑ No (Note: Maximum Freefall Depth is 30 Ft) <br />GROUT SPECIFICATIONS Temporary 1/4" diameter vapor probes set at 10', 20', and 30' in each soil vapor probe boring with <br />B-5 and B-6 hydrated and/or slurry bentonite used as grout and placed at selected depths via tremie pipe, vapor <br />DESTRUCTION WORK TO BE PERFORMED: <br /># WELLS TO BE DESTROYED <br />WELL IDs <br />GROUT SPECIFICATIONS_ <br />TREMIE TYPE TO BE USED <br />OMMENTS: f�ve <br />I hereby <br />Signed �� <br />AUGERS ❑HOSE ❑PIPE <br />probe tubing pulled after sampling for each location and bore hole capped with Portland cement. <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY) (over -bore only if site is impacted) <br />OVER -BORE DIAMETER of 2.25" inches to depth of �30 feet <br />❑ PRESSURE GROUT To depth of feet below surface <br />❑ EXPLOSIVES From to feet below surface <br />❑ MUSHROOM CAP ❑ 3 feet below surface or feet below surface if >3 feet <br />/ that I am authorized to complete this application and that the work will be done in accordance with <br />Joaquin County Ordinance Codes and Standards, and all other applicable California laws. <br />Print Name David A. Reinsma, PG <br />Application Accepted By: <br />Grout Inspection By/Dates: <br />Destruction Inspection By/Dates: <br />Facilitv/Site Information <br />Title/Company President/Trinity Drilling, Inc. <br />Date August 23, 2022 <br />PARTMENT USE ONLY <br />FA Name <br />4 <br />C4n� lr �-�e M � I `p"gqo t <br />FA PE <br />Coe zn�j <br />WP Reviewed By <br />� <br />Work Plan Date <br />g <br />Coe: � �� <br />rU C-57 ❑ C-57 Authorization for Other to <br />Sign Permit ❑ Worker's Comp ❑ Worker's Comp <br />Waiver ❑ Encroachment Permit ❑ Access <br />Agreement ❑ Lead <br />Agency <br />Approval jkMFR <br />COMMENTS/CONDITIONS: S e <br />I+x- i� r ro ,'n <br />9 <br />�O�ri l ,�o oi5�e, <br />d`I� o a �►' i S u, a,s tN� as 0.S <br />o� ,SV P• �-P re'"e- L � a --Fo. .� <br />{� ria II •C.IVI ,- e � � S <br />S i d i t <br />SV f> rr -,f- <br />�.c <br />� � � <br />S� klo <br />WP TYPE <br />PE <br />SC <br />FEE INFO <br />AMT REMITTED <br />CHECK# <br />RECV'D BY <br />DATE <br />P�EyRMIT# <br />INVOICE# <br />Permit <br />21c <br />3 13 <br />1$15&x7C <br />Z <br />3 0 2 <br />CC <br />p�WELL <br />V" oO "1 <br />D <br />¢ -D gq <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F <br />EHD 29-01 04-04-07 <br />Sle. vo�- <br />209 464-0138 � www.s�cehd.com p�'►i. . � <br />Site Mitigation Well Permit Application <br />
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