FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN Environmental Health Department COUNTY C,rentness grows (tern. 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 Couniv Deevelooment Title,Chapter 9-1116.3, and the San Joaquin County Well Standards. Job Address Lat/Long 37.94124057881-121.319257485) �N5 V-Clty/StatelZip Stockton,CA95203 Phone Cross Street APN Multiple APNs v� Property Owner` Burlington Northern and Santa Fe Railway P one 901495-3778 T Address L L( A l6 (-1 ° CltylStateizl / C-57 Contractor Confluence Technical Services,Inc. License# 1035266 Z, } z Phone 707-639-7709 &63Address 6821 81h Street City/State/Zip Rio Linda,bA 95673 1o/IOl t,ConsultanVSub-Contractor License# Phone Mg,5 Address City/State/Zip t'y`)�-CONSTRUCTION WORK TO BE PERFORMED: *Note: OBsite Borin sNVells Require Access g q Agreements or Encroachment Permits TYPE OF WELLIBORINO NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS - ❑ MONDORING IM HOLLOWSTEM BORING DEPTH 5to 10itbgs ❑ROLTEDTRAFFICBOX ❑STOVE PIPE ❑ EXTRACTION(Vaparwater) ❑ HAMMERNRIVEN DIA.OF BOREHOLE 2.251n ❑MULTIPLECAsINGsn MULTI-IEVELWELLGASING DIA ❑ SOILVAPORPROBE ❑ MUDROTARY CASINGTHICKNESS TYPEOF CASING: ❑STEEL ❑PVC ❑ OTHER 12 SOILBORING 7 0 PUSH POINT(GP/CPT) CONDUCTORCASING ❑Yes ❑No Baing DIX Caskg DIX CasNg Depth: ❑ INJECTION W some.ozmel 0 HANDAUGER GROUT SEAL DEPTH TREMIETYPETO REUSED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER OTHER GROUT SEAL PUMPED? ❑Yes ❑No (Note:MaJawin Fmefal Depth is 30 F0 - WEWSOILBORINGII 122-S 1035 10930115S0: ROUT SPECIFICATIONS malcement 1nso;t DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED [I OVER-BORE DIAMETER of_Inches to depth of_feel WELL Ds ❑PRESSURE GROUT To depth of_feel below surface GROUT SPECIFICATIONS El EXPLOSIVES From_to_feel below surface TREMIE TYPE TO BE USED [I AUGERS [I HOSE [I PIPE MU ROOMG 3feet belax ud ceor f tbelaM surface it>3 feet COMMENTS: Thane are multiple locations(see attached map) ' L' ` "' Yr'Lr rL ulQ �y S " ) n 4 `( o 4( o �0 2022 ern 4 l� 17 _�rs�rn`�`./�c�1. I hereby certify that I authorized to complete this application and that the work will be done In accordance with k3 i l San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. rIV, Vnnnyyyy '111 Signed d Title/Company President/Confluence Technical Services Inc' Print Name Date - - 03/ 9/2024 ' CL(j� 0. 1 1 civ� DEPART ENT USE ONLY 1 > QciAAu`, Application Accepted By: - Dale Issued: .5 L 0 V-'hhtih Grout Inspection By/Dates: Destruction Inspection By/Dates: Facllit /Slte Information �' LL FA Name ly\ S - FAAddress ?-2-0I C_& �I7U T(�A FA# OQ L22 rJ 4� I PR# Q .3� FA PE 2cl 50 WP Reviewed By Work Plan Del S 4(lC- 7 ❑C57AIdMrizat1onforOlhato Sign Permit ❑Wakens Oanp ❑Wakens CaapWaher ❑ErvwoKhmnlPermil n' n"I LeadAgen4Appmval FR COM ENTS/CONDITIONS: N n IGr N11(.Q,S J "rQ,flat QA�' O� - S�t-e I ; 5 BYi +� 1 y Ie �t�( ��t�. 5�4J,r4 ► U - s c ut s , sz WP TYPE PE SC FEE INFO AMTREMITIED CHECK# RECV'DBfl DA E I WELL PERMIT# INVOICE# Permit 2�t0 s X 3 G�}} 6 1868 E. Hazelton Avenue Stockton, California 6605 1 f L9 468-3420� 209 464-0138 1 WwWSjjcASW 3 EHD 29 01 N-20-23 Site Milgallm Wea Peed(Appllwdw