Laserfiche WebLink
SAN JUAUUIN <br />f rcatoe:,ss (f!'ti vl:s stere: <br />Environmental Health Department <br />SITE MITIGATION WELL Ot BORING PERMIT APPLICATION <br />NON-REFUNDABLE 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 made in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. <br />Job Address <br />Lat/long: 37.952495, -121.360690 <br />Cross Street Port of Stockton Expy and KA Cl <br />erOwner* Port of Stockton <br />Propty <br />Address 627 N Port of Stockton Expy <br />C-57 Contractor Gregg Drilling, LLC <br />Address 950 Howe Road <br />Consultant/Sub-Contractor <br />1200 HUMPHREYS City/State/Zip <br />Ave <br />Stockton, CA 95203 <br />APN 16203007 <br />City/StatelZip <br />Stockton, CA 95203 <br /># 1044456 <br />License <br />City/StatelZip <br />License# <br />City/StatelZip <br />Martinez, CA 94553 <br />Phone <br />Phone <br />Phone 925-313-5800 <br />Phone <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br />TYPE OF WPI <br />LIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />41 <br />LLOW STEM BORING DEPTH z5' ❑BOLTED TRAFFIC BOX ❑STOVE PIPE <br />ElEXTRACTION (Vapor/Water) ❑ HAMMER/DRIVEN DIA. OF BOREHOLE 2" ElMULTIPLE CASINGS ElMULTI-LEVELWELL CASING DIA <br />El SOILVAPORPROBE E:1MUD ROTARY CASING THICKNESS TYPE OF CASING: ElSTEEL ® PVC ElOTHER temporary 1" PVC casing <br />M SOIL BORING 22 [1PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes © No Boring Dia: Casing Dia: Casing Depth: <br />ElINJECTION (Air Sparge, ozone) ElHAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ElAUGERS ElHOSE ® PIPE <br />ElOTHER El OTHER: DPT F GROUT SEAL PUMPED? ElYes ElNo (Note: Maximum Freefall Depth is 30 Ft) <br />WELL/ SOIL BORING IDs See boring and well IN in comments section GROUT SPECIFICATIONS Neat cement, msut be tremied if water is encountered <br />Revised per Jocelyn Goulette by phone on 9/16/2021 <br />.DESTRUCTION WORK TO BE PERFORMED. <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br />❑ OVER -BORE DIAMETER of inches to depth of feet <br />WELL IDS See temporarywellIDsbelow r-iZPREGGYRE GRE) rr-r_depth of ' feet below surface <br />GROUT SPECIFICATIONS Portland cement/5%bentonite mix ❑ EXPLOSIVES From to feet below surface <br />TREMIE TYPE TO BE USED ❑ AUGERS ❑ HOSE ❑x PIPE ❑ MUSHROOM CAP El3 feet below surface or feet below surface if >3 feet <br />COMMENTS: All borings are temporary and groundwater samples will be grab samples using temporary PVC casing. Borings will be backfilled following sample collection. <br />Sfte3SB01 through-S804ISite3-T1N01 through-TV1104; Site45-S[301 through-SB031Site45-TW01 through -TW03; Site19-SB01 through-SB05I8ite19-TW01 through-T1N05; A0001-SB01 through - 3B05IA0C01-1W01 through -TW05; <br />A00O2-S801 through-8605/A00O2-TW01 th <br />Signed_ <br />Print Name <br />rough -TW05 <br />1 hereby certify that I am authorized to complete this application and that the work will be done in accordance with <br />San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. <br />Tim Boyd <br />Application Accepted By: JEFFCREY WONG <br />Grout Inspection By/Dates: <br />Destruction Inspection By/Dates: <br />Facility/Site Information <br />Title/Company Division Manager, Gregg Drilling, LLC <br />Date os/z3/zozl <br />DEPARTMENT USE ONLY <br />Date Issued: 9/16/2021 <br />FA Name <br />Fornler Naval <br />(NTCS) <br />FA Address <br />1200 HUMPHREYS <br />FA# <br />FA006 25 <br />PR# <br />pR0505342 <br />FA PE <br />2960 <br />WP Reviewed By <br />� <br />Work Plan Date <br />Aug 2021 (Trevet Bayw <br />[XC -57 <br />ElC-57 Authorization for Other to Sign Permit <br />❑ Workers Comp <br />❑ Worker's Comp Waiver ❑ Encroachment Permit <br />ElAccess Agreement [X Lead Agency <br />Approval [NMFR <br />COMMENTS/CONDITIONS: <br />_ 22 borings only, no MW installation or destruction. Inspector: see <br />- Submit report / results to EHD per SJC Well Standards 13.7.2 <br />Fig 17-1 to 17-5 for boring <br />locations <br />WP TYPE <br />PE <br />SC <br />I FEE INFO <br />AMT REMITTED <br />CHECK# <br />RECV'D BY <br />DATE <br />WELL PERMIT# <br />INVOICE# <br />Permit <br />2905 <br />313 <br />1$152 x 6 <br />1 912 <br />cc <br />JW <br />9/10/2021 <br />WP0042548 <br />CONFIRMATION # 131512551 <br />1868 E. Hazelton Avenue � Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 vvww.sjgov.org/ehd <br />EHD 29-01 06-28-21 Site Mitigation Well Permit Application <br />'st) <br />