WORK PLANS - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN Environmental Health Department COUNTY— i, . v Crentnesm grov:s hrre. 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 9-1116.3, and the San Joaquin County Well Standards. Job Address 401 North San Jose Street City/State/zip Stockton, CA 95203 Phon cross street North San Jose Street and West Lindsay Street APN 13526016 u ; f re* al Property Owner*(Chevron Environmental Management Compan� P � ��gh i .j. -yto?y Paone 952-842-1000 Address 6101 Bollinger Canyon Road 53 Y•A.JC- 4wI60rCIty/StatejZIp San Ramon � CA 94583 ply' C-57 Contractor Cascade Drilling �(, 'License# l Q L� ry _j Ph n )�� `�`�- Address 3459 Collins Avenue City/staleizip Richmond CA 94806 '� -1 YDv Consultant/Sub-ContractorArcadis License# Phone 925-274-1100 Address 101 Creekside Ridge Ct CitylState/Zip Roseville, CA 95678 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits TYPE OFWELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOWSTEM BORING DEPTH 25 feet 10 BOLTED TRAFFIC BOX ❑STOVE PIPE RACTION(VaponWater) [IHAMMERNWVEN DIA.OFBOREHOLE 21nchas [I MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA gQrkA 8OILVAPORPR9BIf Welt> 11 ❑ MUD ROTARY CASING THICKNESS N/A TYPE OF CASING: ❑STEEL [I PVC ❑ OTHER 6, Y'_ ® PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes 10 No Bohn9 D o: Casing De: Casing Depth: j I JJECT NtNtAisoaae.Oz. Ld HANDAUGER GROUTSEALDEPTH TREMIETYPETO BE USED: ❑AUGERS ❑HOSE ❑PIPE J OTHER [IOTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 FQ WELUI 911L BORING IDs SV-10,SV-11,SV-12,SV-13,SV-14,SV-15, GROUT SPECIFICATIONS JL P ESSTTRUCTION WORK TO BE PERFORMED: �� SDESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED Se c4-I W OVER-BORE DIAMETER of_inches to depth of feet WELL IDs PRESSURE GROUT To depth of feel below surface GROUT SPECIFICATIONS [I EXPLOSIVES From to feelbelowsudace TREMIE TYPE TO BE USED ❑AUGERS ❑ HOSE ❑ PIPE [I MUSHROOM CAP ❑ 3 feel below surface or feel below surface if>3 feel COMMENTS: Soil borings will be backfilled to 8 feet below group surface(bgs). Dual nested vapor probes will beset from approximately .2510 7.75 fee`bgs and approximately 3.25 to 3.75. Near the surface, probes will be completed with approximately 6 inches of concrete andy, e $ : HI I "" completed with a flushmounled well box. Surfaces of each soil vapor probe will be restored to match the surrounding surfs s. a+yu' to •t 4n r 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. Signed �11.114^�- Title/Company Project Manager/Arcadis U.S., Inc. Print Name Audrina Lehman Date 9/5/2023 PARTMENT USE ONLY Application Accepted By: kjw Date Issued: Grout Inspection By/Dates: v7w, in Destruction Inspection By/Dales: Facilit /Sit nfo atlon FA NameVif-f-rtFA Address FA# Q PR# FA PE WP Reviewed By Work Plan Date 3 Z 6 ZOZZ ❑G-57 ❑C-57Authorization for Other to Sign Permit ❑Workers Camp ❑Workers Comp Waiver ElEmoachmentPenniKElAccassAilreementj ead Agency Appr R COMMENTSICONDITIONS:.rw,— `I7Q�/N h4tJ SBrI \/&f�r V,)e S Mb1.S ie 9 Cam Jr no t�'.cs �'u b� u r S e parb Pe rnd t J !' / It;s r+spevtsr 1 r}ky .j e i WP TYPE PE Sc FEE INFO AMT RENUrrr9Dj CHECK# I RECV-D BY DATE WELL PE MIT# INVOICE �k Permit (//©1 l $�6/s K 5 l r S - VIII I/ZJ C4�'3o -r 8o)r ooDg lfl 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-01 8 www.sjcehd.com EHD 29-01 04-04-07 Site Mitigation Well Permit Appricauon