Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br /> COUNTY- - <br /> 4ronr.r Greatness groves hem. <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 24 Hours Advance Notice Required For All Inspections <br /> CALL (209) 953-7697 For INSPECTIONS <br /> Application is hereby made to San Joaquin County for a permit to Construct and/or Install the work described. <br /> This application is made In compliance With San Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. <br /> Job Address 9500 West Linne Road rif,nmtatolzip Tracy. CA 95377 Phone Not provided <br /> Gross street South MacArthur Drive APN 253-120-48 <br /> Property Owner' Teichert Land Corp Phone 916-484-3272 <br /> Address 3500 American River Drive City/State/Zip Sacramento, CA 95864 <br /> C-57 Contractor EnProbe Environmental Direct Push Drilling Services(EnPfobe) License# 1012248 Phone 530-659-2019 <br /> Address PO Box 6093 City/StatelZip Oroville,CA 95966 <br /> Consultant/Sub-contractor Partner Engineering & Science, Inc. License# N/A Phone 774-414-3666 <br /> Address 2154 Torrance Boulevard city/state/zip Torrance, CA 90501 (Michel Helou) <br /> CONSTRUCTION WORK TO BE PERFORMED:*Note: Offshe Borings/Wells Require Access Agreements or Encroachment Permits <br /> TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 10 ❑BOLTEDTRAFFIC BOX ❑STOVE PIPE <br /> ❑ EXTRACTION(VapalWater) ❑ HAMMER/DRIVEN DIA.OFDOREHOLE ZW ❑MULTIPLE CASINGS❑MULT4LEVELWELLCASING DIA <br /> ❑ SOILVAPORPROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: OSTEEL OPVC 0 OTHER <br /> El SOILBORING 10 (M PUSH POINT(GP/CPT) CONWCTORCASING ❑Yes ONo Boring Dia: Caslrgga Casing Depth: <br /> ❑ INJECTION Wrapeo.oz,i 0 HANDAUGER GROUTSEALDEPTH TREMIETYPETOBEUSED: (3AUGERIi ❑HOSE OHPE <br /> ❑ OTHER ❑ OTHER GROUT SEAL PUMPED? ❑Yes ONo (Note:MadmamFreelall Depth Is30TO <br /> WELUSOILBORINGIOS 61-B10 GROUT SPECIFICATIONS Neat Cement grout viatremmie <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br /> #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of feet <br /> WELL Me ❑PRESSUREGROUT To depth of feet below surface <br /> GROUT SPECIFICATIONS ❑EXPLOSIVES From_to_feelbelow surface <br /> TREMIE TYPE TO BE USED [I AUGERS ❑HOSE [I PIPE ❑MUSHROOMCAP ❑3 feet below surface or feel balm surface if>3 feel <br /> COMMENTS: No soil vapor sampling <br /> 1 hereby certify that I am authorized to complete this application and that the work will be done in accordance with <br /> San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. <br /> Signed 9.lic%G/0' Title/Company Project Manager/Partner Engineering &Science, Inc. <br /> Print Name Michel Helou Date 8/23/2023 <br /> DEPARTMENT USE ONLY ^7 9 <br /> Application Accepted By: Date Issued: z <br /> Grout Inspection By/Dales: z -Vn <br /> Destruction Inspection By/Dales: <br /> Facilit ISite Information jW <br /> FA Name ttr IV I FAAddmss ill FA# 160 2-44 q- PR# <br /> FA PE V WP Reviewed BY w I Work Plan Date Si Z 0z <br /> ❑G57 G57 Aulhorizagon fer Other to Sign Permit ❑Workers Camp ❑Wamkees CanpWWW ❑E=advnent Pemdt OAaassAgreeirenl ❑Lead Agency Approval PLMFR <br /> COMMENTS/ O DITIONS: .SAL ) / <br /> 0 U12 ; 0rI&a' S s { � -I/ a i 1 vL1 WQ � 1'1"S Aose ftYaQSt� 4 L <br /> JWPTYPEJ PE I SC I FEE INF�O1 AMT REMITTED CHECK# REC�V''D Y o'/DATE WELL PERCNUT#7 INVOICE# <br /> Permit ( $16�x rT Z -.1 5/7A23 tO�-6 z <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 Sjc cbk'7 <br /> EHDN-0104-20-23 !^ /' '+I 1 rT Site Midgatim Well Permit Application <br />