Laserfiche WebLink
Signed x <br />Print Name Gavin 0. McCrearv <br />Apr, 1. 2008 9:27AM Advanced GecEnv: ronmental No, 1590 P. 2 <br />San Joaquin County <br />Environmental Health Department SITE <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95 <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.orgiehd <br />t5:2EZVLITIGATION _ Ly9 UNIT IV <br />A <br />Well Permit Application <br />mi <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISktitIRONT„MENT HEAL FH <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work desorib cePINVeOltoltli'll#ade 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 />WELL Location 345 N 'Yosemite street Cross Street W Fremont St City StocKch. Zip 95203 Parcet# 135-260-11 <br />PROPERTY <br />Ownerrerry McDonald Address 345 N Yosemite StreetCity stockton Zip95203 Phone# (209)466-2200 , <br />C-57 Contractor 11; Irh et/I)riiii.iy Address 7900 117 r ve He A City E. zipq no2Lic# 7261 ) <br /> <br />Phone# (70 7 0+0 <br />Consultant/Sub Cntr Advanced GeQ,Ellvi.pzutealAddrOSS R -47 3b8w City Stockton Lic# 0227 Phone# (205)467-1006 <br />GIS Coordinates: X <br /> <br /> , Township <br /> <br />Range Section <br /> <br />WORK TO BE PERFORMED: <br />ft NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER') <br />la SOIL BORING# MW-10, -11, -12, -13 <br />WELL # <br />D 'Other <br />COMMENTS: <br />INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />fl HOLLOW STEM DIA. OF BOREHOLE" 0 MULTIPLE CASINGS a MULTI-LEVEL WELL CASING DIA: <br />I] AIR HAMMER/DRIVEN CASING THICKNESS Schedle 4 OTYPE OF CASING: 0 STEEL (PVC a OTHER: <br />0 MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: a AUGERS a HOSE <br />g PUSH POINT (GP Or CPT)GROUT SEAL PUMPED: U Yes cf No (NOTE: MAXIMUM FREE-FALL DEPTH IS 30') <br />fl HAND AUGER GROUT SPECIFICATIONS Portland Neat Cement <br />0 OTHER APPROX. BORING DEPTH 33 20 (3x) [r BOLTED TRAFFIC BOX or a STOVE PIPE <br />CONDUCTOR CASING PROPOSED (if YES, list specifications in comment section) <br />COMMENTS! <br />NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS. _ <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS. <br />I hereby certify that I have • repared this application and that the work will be done in accordance with San Joaquin <br />County Or ances, and Regul ti , nd all applicable California State Laws. <br />DESTRUCTION (choose type below) <br />U OVER-BORE. DIAMETER <br />fl PRESSURE GROUT <br />GROUT SPECIFICATIONS <br />TYPE OF WELL <br />(f MONITORING <br />Ii EXTRACTION <br />D VAPOR <br />a AIR SPARGE/ OZONE <br />(I SOIL BORING <br />a OTHER: <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS: 371— <br />WORK PLAN DATED: <br />Date Issued <br />Date'/(J1/c1 Final Inspection By <br />Destruction Inspection By Date <br />COMMENTS I CONDITIONS Loke if)4-11) <br />Title/Company Staff Scienti st /AGE <br />Date 11 March 2008 <br />Application AcC,epted By 741 <br />Grout Inspection By P- <br /> Ar a <br />Date M D <br />ACCOUNTING ONLY: AID# FAC# <br />PE CODES FEE INFO AMOUNT REMITTED CHECK # REC'D BY DATE EOUEST # INVOICE <br />YOI 8q e 3- -1 ii- GO 4e WVOkSR#001-1? '5' d <br />C-57 WC -WAIVER <br />EHD 29-02-001 <br />3,0T e/ <br />AM/ild <br />C-57 Letter of Authorization to sign perm <br /> <br />It