Laserfiche WebLink
G �� <br />San Joaquin County ��� <br />P R I G INA L <br />Environmental Health Department SEP 1 9 2007 SITE <br />600 E. Main Street, Stockton, CA 95202-3029I�IILGATION <br />(209) 468-3449 Fax: (209) 468-3433 Web: www.sjgov.org/1-WIRON[4IEN'T HEAL NIT IV <br />Well Permit Application PERMIT/SERVICES <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />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 <br />Joaquin County Development Title, Chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />Reid Drive Luce Ave. Stockton Assessors// q a�� <br />WELL Location Cross Street City Zip Parcel# 611- / <br />PROPERTY Port of Stockton 2201 W. Washington St. Stockton 95201 (209) 946-0246 <br />Owner Address City Zip Phone# <br />C-57 Contractor RSI Drilling Address 220 N. East Street City Woodland Zip Lic# 802334,hone# (530) 668-2424 <br />Consultant / Sub Cntr WGR Southwest, Inc. <br />�f�Address 315 W. Pine St. Ste 8 City Lodi Lie# Phone# (209) 334-5363 <br />GIS Coordinates: X31. G QY jv• Township Range Section <br />WORK TO BE PERFORMED: <br />p NEW WELL / BORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER*) p DESTRUCTION (choose type below) <br />X SOIL BORING # 8 a OVER -BORE. DIAMETER <br />a WELL # a PRESSURE GROUT <br />a *Other GROUT SPECIFICATIONS <br />COMMENTS: -- <br />TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />a MONITORING a HOLLOW STEM DIA. OF BOREHOLE_ 2„ _ MULTIPLE CASINGS D MULTI-LEVEL WELL CASING DIA: <br />Q EXTRACTION a AIR HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: a STEEL u PVC a OTHER: <br />0 VAPOR a MUD ROTARY DEPTH OF GROUT SEAL_ 6' TREMIE TYPE TO BE USED: GAUGERS a HOSE <br />Q AIR SPARGE/ OZONE X PUSH POINT (GP or CPT)GROUT SEAL PUMPED: p Yes X No (NOTE: MAXIMUM FREE -FALL DEPTH IS 30') <br />X SOIL BORING p HAND AUGER GROUT SPECIFICATIONS_ Bentonite pellets <br />a OTHER: a OTHER APPROX. BORING DEPTH 6' Max a BOLTED TRAFFIC BOX or O 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 prepared this application and that the work will be done in accordance with San Joaquin <br />County Or ances, Rules and Regulations, and all applicable California State Laws. <br />Project Manager WGR Southwest <br />Signed x cel" Title/Company <br />Print Name Caryl 4heehan Date 04 Sep 2007 <br />DEPARTMENT USE ONLY <br />SITE MAP IN UNIT IV FILE, ADDRESS: E'c_� — QS L <br />WORK PLAN DATED: <br />Application Accepted By Date Issued Area D(2 <br />Grout Inspection By Date Final Inspection B __._ - -Date ly'�0�o3 <br />Destruction Inspection By Date --" <br />COMMENTS / CONDITIONS: — <br />ACCOUNTING ONLY: AID# FAC# 'S Ro O� <br />PE CODES <br />FEE INFO AMOUNT REMITTED <br />CHECK # REC'D BY <br />DATE PERMIT / VICE REQUEST # <br />INVOICE <br />��,o SR# 652 a 2� <br />C-57_ WC= WAIVER_ C-57 Letter of Authorization to sign permi t_Z Encroachment docff,41"1- <br />EHD 29-02-001web <br />6/22/04 <br />11 <br />S <br />1 <br />