FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

ORIGINAL SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT LOP 1868 East Hazelton Avenue, Stockton,CA 95205-6232 SITE MITIGATION % Telephone: (209)468-3464 Fax:(209)468-3433 Web:www.sluov.or4/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 800 West Church St Cross Street Stockton St City Stockton Zip 95203 APN 14523004 Property Owner The Newark Group Address 2575 Grand Canal Blvd City Stockton Zip 95207 hone(209)476-7710 C-57 Contractor Gregg Drilling_ Address 950 Howe Rd City Martinez Lic 485165 Phone(925)313-5800 Consultant/Sub Cntr Gens3mtec Address 1111 Broadway City Oakland Lic Phone (510)836-3034 Billable Party Cascades,Inc. Address 471 Marie-Victorin City K.ingsey Falls Zip J0A 1B0 Phone (819)363-5702 GIS Coordinates:X -121.302736 Y 37.943958 (Quebec),Canada CONSTRUCTION WORK 10 BE PERFORMED: IBI NEW WELUBORIN CPT EOPROB YDROPUNC AND-AUGER,OTHER) ❑SOIL BORING IDs; ! ❑WELL IDs ®OTHER IDs CPT-2012-01 through CPT-2012-18 with possibility of 2-3 additional/provisional locations O TYPE&#OF WELUBORING INSTALLATION TYPE NA CONSTRUCTION SPECIFICATIONS NA _❑MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER _ _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL 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) _❑INJECTION(i.e.Airsoaroe.Ozone)❑HAND AUGER GROUT SPECIFICATIONS A/E✓�� EIMfIOT (� 21®OTHER: CPT/HP ❑OTHER: APPROX.BORING DEPTH yn' ❑BOLTED TRAFFIC BOX OR ❑STOVEPIPE CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth: Boring Dia: COMMENTS: 1 CPT and 1-7 hydropunch borings ner location Neat cement grout backfill 1won removal, NOTE: OFFSITE WELLS$BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) LA #OF WELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT WELL IDs; ❑PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE GROUT SPECIFICATIONS ❑EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED:0 AUGERS 0 HOSE PIPE ❑MUSHROOM CAP AT(>3 FT) FT BELOW SURFACE COMMENTS -� e 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 Ordlnances,Rures and Regulations,and all applicable California Laws. Signed Title/Company Renin Staff Engineer Flensyntec C oncnitantc Print Name Tony Smith Date 17 July 2012 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE SITE ADDRESS (966 (,) - scl�I._cc2Pkt tameT, Y-12C f' k) WORK PLAN DATED j(4 I Z ='! APPLICATION ACCEPTED BY J.Kt7A'<"W1 DATE A � GROUT INSPECTION BY FINAL INSPECTION BY DESTRUCTION INSPECTION BY DATE COMMENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RD# INVOICE REQUESS/T PR# �(9O 5 $125X pave Ll 7-P, 7`J 7�P- SR# b3 10 3 3�5 1 9 e (3500) PR# 2900 C-57 _ WC ✓ WAIVER LV� C57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC__/