Laserfiche WebLink
an Joaquin County <br />EnviMmental Health Department <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202 <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/ehd <br /> <br /> <br />SITE <br />MITIGATION <br />UNIT IV <br /> <br />GINA <br />N-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED VRUN1 ,i-r <br />!Prin <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. ThisrapbliCation 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 />Assessors <br />Cross Street Lincoln City Stockton zip 95206 Parcel# 165-040-13 <br />PROPERTY <br />Owner LOPEZ, NEREIDA P Address PO BOX 6569 -- City Stockton zip 95206 Phone2099444523 # <br /> <br />C-57 Contractor Gregg Drilling Address 950 Howe Road City Martinez Zip 94553 LiG# 656407 Phone# 925-313-5800 <br />Consultant / Sub Cntr Advanced aeoEnvironmentai Address A17 gliAwm City Stockton LiC# Fl(-)227 Phone# (209)467-1006 <br />GIS Coordinates: X <br /> <br />, Y Township Range Section <br /> <br />° Well Permit Application AUG 7 20 0 <br />WELL Location 1601 Turnpike Rd. <br />WORK TO BE PERFORMED: <br />fi NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER*) <br />U SOIL BORING # <br />Ei WELL # MW-9,MW-10,MW-11 <br />O *Other <br />a DESTRUCTION (choose type below) <br />0 OVER-BORE. DIAMETER a PRESSURE GROUT <br />GROUT SPECIFICATIONS <br />COMMENTS: <br />TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />0 MONITORING IT HOLLOW STEM DIA. OF BOREHOLE 8" a MULTIPLE CASINGS a MULTI-LEVEL WELL CASING DIA: 2" <br />a EXTRACTION 0 AIR HAMMER/DRIVEN CASING THICKNESS SCHD 40 TYPE OF CASING: a STEEL B PVC a OTHER: <br />0 VAPOR a MUD ROTARY DEPTH OF GROUT SEAL 50-105' TREMIE TYPE TO BE USED: EfAUGERS 0 HOSE <br />0 AIR SPARGE/ OZONE a PUSH POINT (GP or CPT)GROUT SEAL PUMPED: EYes 0 No (NOTE: MAXIMUM FREE-FA/ / DEPTH IS 30') <br />0 SOIL BORING a HAND AUGER GROUT SPECIFICATIONS Portland Type II <br />a OTHER: a OTHER APPROX. BORING DEPTH 65-120' B BOLTED TRAFFIC BOX or a STOVE PIPE <br />CONDUCTOR CASING PROPOSED na (if YES, list specifications in comment section) <br />COMMENTS: <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. <br />4U WORKING HOURS NOTICE REQUIRED FOR 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 n Regulations, and all applicable California State Laws. <br />Signed x <br /> <br />Title/Company Environmental Scientist <br /> <br />Print Name Ally Colavita Date 8/7/7 <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS: 11,0 I TUrn 10;k-e- R d <br />WORK PLAN DATED: May 21 ,QoarT <br />Vi-c.,-1-vy; L. Me..ea r+ney Date Issued Application Accepted By <br />Final Inspection By <br />Dat <br />s /'1a7 <br />Area 14 51 <br />etirLyve,-/ Date <br /> Is-Cy? Grout Inspection By VI-1/1-b ;crt Yn earl—n.42.'7 Date <br />Destruction Inspection By <br />COMMENTS / CONDITIONS: It Gi 4'; Q n of MW Mw - ID and M IA/ - II <br />ACCOUNTING ONLY: AID# <br />- <br />FAC# <br />_ <br />PE CODES FEE INFO AMOUNT REMITTED CHECK # 5 EC'D BY DATE INVOICE - i.:-_-_ # <br />35o1 <br />35-03 <br />4/ 89 <br />294 <br />4r „ .D ,., 0, c.). 00 25825 ,-1/P? 8-8 -o• SR# 00615-61, <br />C-57 WC -WAIVER C-57 Letter of Authorization to sign permit Encroac men doc <br /> <br />EHD29-02-001 <br />6/22/04