WP0042940 - Laserfiche WebLink

Home Browse Search

SAN 10A0UIN �rODtness grans Dere. Environmental Health Department SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Advance Notice Required For All Inspections CALL (209) 953-7697 For INSPECTIONS 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 San Joaquin County Well Standards, Job Address Near 306 West 6th Street 560 S. TRACY BLVD Cross Street Central Ave Property Owner* Union Pacific Railroad (UPRR Address 1400 Douglas St, Stop 1030 C-57 Contractor Penecore Drilling City/State/Zip Tracy, CA, 95376 AP 235-150-060 City/state/Zip Omaha, NE, 68179 License# 906899 Phone N/A Phone N/A Phone 530.661.3600 Address 220 N. East Street City/State/Zip Woodland,CA, 95776 Cons ultantlSub-Contractor Arcadis US. Inc. License# N/A Phone Address 735 Tank Farm Road Suite 150 City/State/Zip San Luis Obispo, CA, 93401 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits 805.459.2391 TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 10.0 ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION (VaporMater) ❑ HAMMER/DRIVEN DIA. OF BOREHOLE 3 In ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER IN SOIL BORING 8 ❑ PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes ❑ No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION (Air sparge, ozone) ® HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑ Yes ❑ No (Note: Maximum Freefall Depth is 30 Ft) WELUSOIL BORING IDS TRY -29A through TRY -29H GROUT SPECIFICATIONS Neat Cement (tremmie if groundwater is encountered) DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER -BORE DIAMETER of inches to depth of feet WELL IDs ❑ PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑ EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑ AUGERS DOSE [PIPE ❑ MUSHROOM CAP ❑ 3 feet below surface or feet below surface if>3 feet COMMENTS: All borings will be hand augered to TD and subsequently abandoned using neat cement. Signed Print Name I hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. A,}ZQ Title/Company Project Manager, Arcadis US., Inc. Christine Perez Date 01/10/22 DEPARTMENT USE ONLY Application Accepted By: JEFFREY WONG Date Issued: 1!26/2022 Grout Inspection By/Dates: Destruction Inspection By/Dates: Facility/Site Information FA Name c nfirmati ## 378845 SR0084772 1868 E. Hazelton venue ��#oc�3on, Callornia 95205 � T 209 468-3420 � F 209 464-0138 1 wvvw.sjgov.org/ehd EHD 29-01 06-28-21 Site Mitigati Chevron TAOC 6th Street FA Address 11 th W Sixth FA# FA0015928 PR# PR0523598 FA PE 2850 WP Reviewed By J�/�/ Work Plan Date 4/29/2014 ❑ C-57 ❑ G57 Authorization for Other to Sign Permit ❑ Worker's Comp ❑ Workers Comp Waiver ❑ Encroachment Permit ❑ Access Agreement ❑ Lead Agency Approval ❑ MFR COMMENTS/CONDITIONS: Submit a copy of the report per SJC Well Standards 13.7.2 WP TYPE PESC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2905 1 313 $152x 3 1 456 cc I JW 11/25/2022 WP0042940 on Well Permit Application