FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

' .oG SAN JOAQUIN COUNTY Fill COPY �e X ENVIRONMENTAL HEALTH DEPARTMENT LOP 1• Te/ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION ;FOR�:P Telephone: (209) 468-3454 Fax: (209) 468-3433 Web: www.sigov.org/ehd UNIT IV WELL & BORING PERMIT APPLICATION FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 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 Standards of the San Joaquin County Environmental Health Department. Site Location 8020 S. Airport Way Cross Street Stimson Street Ci Stockton, CA Property City Zip 95206 APN 177-260-04 Owner CA Army National Guard Address 10620 Mather Blvd. City Mather, CA Zi 95655 P Phone (916) 369-4327 C-57 Contractor Cascade Drilling Address 3000 Duluth Street Cit West Sac., CA OTIE y Lic C57-938110 Phone (916) 638-1169 Consultant/Sub Cntr Address 1777 N. California Blvd., Suite 310 City Walnut Creek, CA Lic N/A Phone (925) 906-9698 x2225 Billable Party CA Army National Guard Address 10620 Mather Blvd. City Mather, CA ZiP 95655 Phone (916) 369-4327 GIS Coordinates: X 37884 Y 121.247 CONSTRUCTION WORK TO BE PERFORMED: 12J( NEW WELUBORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER) ❑ SOIL BORING IDs ❑ WELL IDs ❑ OTHER IDs TYPE & # OF WELUBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑ MONITORING ❑ HOLLOW STEM DIA. OF BOREHOLE 1.5 inch ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA: _❑ EXTRACTION: Vapor/ Water ❑ HAMMER/DRIVEN CASING THICKNESS N/A TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER _❑ SOIL VAPOR PROBE ❑ MUD ROTARY DEPTH OF GROUT SEAL N/A TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE _❑ SOIL BORING ® PUSH POINT (GP/ CPT) GROUT SEAL PUMPED: ❑ Yes ❑ No (MAXIMUM FREE FALL DEPTH IS 30 FT) _22M INJECTION (- oa,-,.e ❑ HAND AUGER GROUT SPECIFICATIONS Boreholes will be abandoned with neat cement —MOTHER: ISCO ❑ OTHER: APPROX. BORING DEPTH 50 ft. ❑ BOLTED TRAFFIC BOX OR ❑ STOVE PIPE G IZEIUICv�t p µr'� 7({!�) tt� ��S CONDUCTOR CASING ❑ No ❑ Yes: Casing Dia: Casing Depth: Boring Dia: COMMENTS: 22 temporary ISCO reagent injection points will be advanced. Boreholes will be abandoned according to SJCEHD's regs. NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: ('CHECK ALL THAT APPLY) # OF WELLS) TO BE DESTROYED WELL IDs: El OVER -BORE DIAMETER OF INCHES TO DEPTH OF FT ❑ GROUT SPECIFICATIONS PRESSURE GROUT To DEPTH OF FT BELOW SURFACE ❑ EXPLOSIVES FROM To FT BELOW SURFACE TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE ❑ MUSHROOM CAP AT >3 F COMMENTS (_ FT BELOW SURFACE 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulationand a I a licabl C or Laws. Signed I M L� TL, Title/Com an LSI We, Print NameL. Imo( j C t—t A -et It j5—L) i Date Jx � ► �j DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE SITE ADDRESS WORK PLAN DATED fu 1-1'L APPLICATION ACCEPTED BY a - dy a Kung DATE IS /�� GROUT INSPECTION BY FINAL INSPECTION BYlik3 /p./_/ DESTRUCTION INSPECTION BY DATE COMMENTS/CONDITIONS.- ACCOUNTING OMMENTS/CONDITIONS: ACCOUNTING ONLY: PE CODES I FEE INFO Cx� $125x �q03 37s !� WC L AID # AMT REMITTED CHECK # !ov z.a 3 LETTER OF AUTHOR FAC # RECV'D BY DATE SERVICE RO # INVOICE REQUEST PR # e�'li+vP7c2 8 ZSvi3 SR# 67SS8 RO # PR # (2900) TO SIGN PERMITy ENCROACHMENT DOC_