Laserfiche WebLink
�t SAN JOAQUIN <br />` <br />"''► COUNTY <br />Greatness grovis here. <br />SIV V091MC 'i" cl C��Ci8�D ri C)�P�rili��� np <br />SITE Will I IGATION WELL & BORING PERlVfll T APPLICATION <br />For Wells and Borings Used for Contaminant Investigations and Remediation <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />48 Hours Advance Notice Required For A11 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 1500 Madruga Road City/State/Zip Lathrop, CA, 95330 Phone 209-482-1730 <br />Cross Street Guthmiller Road <br />Property APN 241-030-330 <br />Owner Paul Bottini <br />Address 1500 Madruga Road <br />City/State/Zip Stockton, CA, 95202 <br />C-57 Contractor ADVANCEDGEO, INC. License# 1063765 <br />Address 837 SHAW ROAD <br />City/State/Zip STOCItTON, CA 95215 <br />ConsultantlSub-ContractorADVANCEDGEO,License# 1063765 <br />Address 837 SHAW ROAD <br />City/StatelZip STOCKTON, CA 95215 <br />Phone 209-482-1730 <br />Phone 209-467-1006 <br />Phone 209-467-1006 <br />CONSTRUCTION WORK TO BE PERFORMED: Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br />TYPE OF WELLIBORING NUMBER <br />❑ MONITORING ❑ <br />❑ EXTRACTION (Vapor/Water) ❑ <br />SOILVAPORPROBE <br />® 2 ❑ <br />INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />HOLLOW STEM BORING DEPTH 5 and 15 <br />HAMMERIDRIVEN DIA. OF BOREHOLE 1.5" and 3" <br />lv1U0 ROTARY CASING THICKNESS <br />® SOIL BORING 5 ® PUSH POINT (GPI CPT) CONDUCTOR CASING <br />❑ BOLTED TRAFFIC BOX ❑STOVE PIPE <br />❑ MULTIPLE CASINGS ❑MULTI-LEVEL VJELL CASING DIA <br />TYPE OF CASING: El STEEL ❑ PVC El OTHER <br />❑Yes ❑ No Boring Dia: Casing Dia: Casing Depth: <br />DEPARTMENT USE ONLY <br />❑ INJECTION (Air Sa�rge, Ozone) ❑ HAND AUGER GROUT SEAL DEPTH 5 and 15 TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ®PIPE <br />[I OTHER El OTHER: GROUT SEAL PUMPED? El Yes ® No (Note: Maximum Freefall Depth is 30 FI) <br />WELL/ SOIL BORING IDs B1•85,V1l2 GROUT SPECIFICATIONS Portland Cement 6 gallons per 94 lbs sack <br />DESTRUCTION WORK TO BE PERFORMS DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br /># WELLS TO BE DESTROYED ❑ OVER -BORE DIAMETER of inches to depth of feet <br />WELL IDs ❑ PRESSURE GROUT To depth of feet below surface <br />GROUT SPECIFICATIONS El EXPLOSIVES From to feet below surface <br />TREMIE TYPE TO BE USED El AUGERS ❑ HOSE El PIPE ❑ MUSHROOM CAP ❑ 3 feet below surface or feet below surface if >3 feet <br />Signed__ <br />9 "" Z <br />I 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 />Title/Company SENIOR GEOLOGIST/A.G.I. <br />Print Name Tim Cuellar Date � • °� p <br />Application Accepted By: <br />Grout Inspection By/Dates: <br />Destruction Inspection By/Dates: <br />FarilihrrRifo Infnrmafinn'Now Aml <br />Date Issued: <br />186 <br />FA Name <br />FA PE <br />1.�OGj <br />WP Reviewed By <br />S <br />Work Plan Date <br />i;I G57 El G57 Authorization for Other to Sign Permit <br />❑ Worker's Comp ❑ Worker's Comp Waiver <br />❑ Encroachment Permit <br />❑ Access Agreement ❑ Lead Agency <br />Approval ❑'MFR <br />COMMENTS/CONDITIONS: ,r,��,� <br />LA'I Q��Nt �V'kZ \ <br />too,CiQ �� <br />WP TYPE <br />PE <br />SC <br />FEE INFO <br />AMTREMITTEDCHECK# <br />RECV'D BY <br />DATE <br />WELL PERMIT# <br />INVOICE# <br />Permit <br />Z�05 <br />3\ j <br />$152x <br />>� <br />�,, <br />1� <br />\to <br />8 E. Hazelton Avenue � Stockton, California 95205 � T 209 4G8-3420 � F <br />EHD 29-01 08-01-17 <br />555 <br />209 4G4-0138 1 I�v�v%,v.sjcehd.com <br />WOO 00V ? <br />Site Idillgelion Well PermilAppli tion <br />