WORK PLANS - Laserfiche WebLink

Home Browse Search

SAN 10AQUIN Environmental Health Department C O U N T Y RECEU V D SITE MITIGATION WELL & BORING PERMIT APPLICATION OCT 3 12017 For Wells and Borings Used for Contaminant Investigations and Remediatipnppr�� NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED J�lallV�91ENTHlFAlT1i 48 Hours Advance Notice Required For All 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 9-1115.3,and the San Joaquin County Well Standards. Job Address 2700 W.Washington Street city/state/zip Stockton,CA Phone Cross Street �j[aW 17riye APN _145-030-12 Property Owner* Buckeye Partners,LP-Jeff Brudereck Phone (610)904-4019 Address Five TEK Park(9999 Hamilton Blvd. City/State/zlp Breinigsyille,PA 18031 C-57 Contractor Cascade Drilling License# 938110 Phone (530) 662-2829 Address 2083 F. Main Street City/Statelzip Woodland,CA 95776 i Consultant/Sub-Contractor_Stantec Consulting Services Lice nse# Phone (916)472-3915 Address 3875 Atherton Road City/State/zip Rocklin,CA 95765 I CONSTRUCTION WORK TO BE PERFORMED:'Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits TYPE OFWELLIBORING NUMBER INSTALLATION TYPE CONSTRU TION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor7Water) ❑ HAMMERIDRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL D PVC❑OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes❑No Boring Die: Casing Die; Casing Depth: ❑ INJECTION(Aw Swat Oxma1 ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED; ❑AUGERS❑HOSE❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes❑No (Note:Maximum Freefall Depth Is 30 Ft) WELL/SOIL BORING IDs GROUT SPECIFICATIONS I DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLYI #WELLS TO BE DESTROYED 34 ®OVER-BORE DIAMETER of A inches to depth of 37 feet WELL IDS OS-32 thru OS-57 n PRESSURE GROUT To depth of 37 feet below surface GROUT SPECIFICATIONS Neat Cement ❑EXPLOSIVES From to feet below surface TR�EMMII �EETYPE TO BE USED ❑AUGERS []HOSE ® ❑PIPE MUSHROOM CAP 3 feet below surface or feet below surface If>3 feet CW elis will be over-bored unless site limitations prohibit access with augers. I hereby certify th I am authorized to complete this application and that the work will be done In accordance with Sa J quin County Ordinance Codes and Standards,and all other applicable Callfomla laws. Signed Title/Company. Sr.Project Manager/Stan tec Print Name Dan Schreiner Date -IbI WI I DEPARTMENT USE ONLY y Application Accepted By: Date Issued: Grout Inspection By/Dates: LA 1 OS— t o -1 S- W- Destruclion Inspection By/Dates: rA I ?um r l'•CJ" acliftylSile Infor stion ) t°f 1V A7-t,1 �jt 0 1� FA Name S ��, FA Address 3 o 0 3 of FA# IOU Z-�•Z_q I PR# FA PE (� WP Reviewed By Work Plan Date JLJ4 C-57 ❑C57 Aulhorization for Other to Sign Permit a ke a( ❑Workers Camp Walver ❑Encroachment Permit []Access Agreement ead Agency Approval G3MFR COMMENTSICONDITIONS: s S i -, / � ��-✓r �� `�/ r� e-- .Q h- WP TYPE PE I SC I FEE INFO JAMT REMITTED1 CHECK#I RECWD BY DATE WELUPERMIT# j INVOICE# Permit -43 $152 x S'— 76 U 3 (C 1 @00 5 1868 E. Hazelton Avenue I Stockton,California 95205 i T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29.01(IM1-17 Site Mitigation Well Permit Application