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SR0036670
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2900 - Site Mitigation Program
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SR0036670
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Entry Properties
Last modified
5/9/2023 11:30:53 AM
Creation date
5/9/2023 11:19:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
RECORD_ID
SR0036670
PE
3501
STREET_NUMBER
2353
STREET_NAME
TOSTE
STREET_TYPE
RD
City
TRACY
APN
238-020-04
ENTERED_DATE
1/20/2004 12:00:00 AM
SITE_LOCATION
2353 TOSTE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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SJGOV\bmascaro
Tags
EHD - Public
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TYPE OF WELL <br />0 MONITORING <br />EXTRACTION <br />0 VAPOR <br />INSTALLATION TYPE <br />..frgOLLOW STEM <br />0 AIR HAMMER/DRIVEN <br />U MUD ROTARY <br />jrAIR SPARGE / Ozone U PUSH POINT <br />U SOIL BORING 0 HAND AUGER <br />0 OTHER: fl OTHER <br /> <br />Z(2 ; (,e0q-- Area Date Issued <br />Final Inspection By Date <br />t <br />WELL . ERMIT APPLICATION ROM <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT (EHD) <br />304 E. Weber, Third Floor, Stockton, CA., 95202 <br />(209) 468-3449 <br /> <br />SITE <br />MITIGATION <br />UNIT IV <br /> <br /> <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />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 <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />, Assessor's <br />WELL Location '2_353 To5iv Ett Cross Street Cloy* Li vie. City TraCii Zip 15 37(a Parcel# 7:3`3 -02.0 "CA <br />PROPERTY Owner Joe 705 k( Address MIA) Tosde. Cal City Ta2C-Al zip q53/6 phone# S35 -695g <br />?..c1Kcikr.) <br />C-57 Contractor tick Dr .1 i Address ki aiw u3c*.4J Cityeav-cko 44), Zip q5b11) Lic# 612(111 Phone# (16)61 g 3 <br />Consultant / Sub Cntr AdkatAriti (leo Clotil. Address 2'51 56A,4 v-A City 5114-'11/1 Lic# 10'20 iZ 7 Phone# i-14, 7 <br />GIS Coordinates: X , Y , Township <br /> <br />Range Section <br /> <br />WORK TO B_ERFORMED: <br />fl NEWELL)BORING ( CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER*) 0 DESTRUCTION (choose type below) <br />SOIL BORING # t t_ a OVER-BORE <br />.2-WELL # " •?( 0 PRESSURE GROUT <br />Grout Specifications: <br /> <br />CONSTRUCTION SPECIFICATIONS <br />CIA. OF BOREHOLE c6 /' MULTIPLE CASINGS? 0 MULTI-LEVEL? a WELL CASING CIA: <br />CASING THICKNESS Cpc_ in 140 TYPE OF CASING: El STEEL 'PVC [J OTHER: <br />DEPTH OF GROUT SEAL ZS 140 ' TREMIE TYPE TO BE USED: yAUGERS U HOSE <br />GROUT SEAL PUMPED: /lefes a No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />GROUT SPECIFICATIONS: po i-MOtt4/1 <br />APPROX. BORING DEPTH - z - ABOLTED TRAFFIC BOX or a STOVE PIPE <br />CONDUCTOR CASING PROPOSED? — ( if YES, list specifications here): <br />*COMMENTS: <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS OR ENCROACHMENT PERMITS. <br />CALL THE UNIT IV INSPECTOR 48 WORKING HOURS IN ADVANCE FOR ALL REQUIRED INSPECTIONS. <br />I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br />County Ordinances, Rules and Regulations, and all applicable California State Laws. <br />Cle_01001`j/ita\ICUAUA (11&) BAVirmAtiiitetA40-1 Title/Company <br />Date -.1A..vvia_ry 19 I ZOO LI <br />SITE MAP IN UNIT IV FILE, ADDRESS: <br />WORK PLAN DATED: <br />Date <br />COMMENTS / CONDMONS: C- <br />ACCOUNTING ONLY: ONLY: AID# c.„f0E2.111,62 7 0' <br />PE CODES FEE INFO AMOUNT REMITTED CHECK # REC'D BY DAT • INVOICE PERMIT /SERVICE REQUEST # <br />I 31 , C' I 1 5)4- $T , ' ( A"_ i\ 3(-.4—'70 <br />*Other: <br />COMMENTS <br />Signed x cA <br />Print Name CV.,-e,AAE, ,,\A. ex- <br />DEPARTMENT USE ONLY <br />Application Accepted By <br />Grout Inspection By <br />Destruction Inspection By <br />C <br />Date <br />C-57 WC -WAIVER C-57 Letter of Authortzatio o sign permit Encroachment doc <br /> <br />8/29/02 <br />
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