Laserfiche WebLink
• ! �� `t <br /> ,. SAN JOAQUIN COUNTY FILE <br /> ENVIRONMENTAL HEALTH DEPARTMENT LOP, <br /> 600 East Main Street, Stockton,CA 95202-3029 SITE MITIGATION <br /> Telephone:(209)468-3454 Fax:(209)468-3433 Web:www.sigov.org/ehd UNIT IV <br /> WELL & BORING PERMIT APPLICATION <br /> FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION <br /> NON REFI NDARI P PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application is hereby made to San Joaquin County for a permit to ConsWct 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 the San Joaquin County Environmental Health Department. <br /> ISOSite Location D'Arcy Parkway Cross Street S.Howland Rd City Lathrop Zip yS 130 APN 196.13.032 <br /> Property <br /> Owner a.«wen.«.r s.wswwc.n«.n« Address 4100 Newport Place,Ste 800 CRY Newport Beach Zip 92660 Phone 948-281-7010 <br /> C•57 contractor VannuW Technologies Address PO Box 791 City Woodland Lic 611 760 Phone 530-219-26d <br /> Consultan9Sub Cntr Stantec Address 370 North Wget Ln.Ste.210 Cit, Walnut Creek L(c Phone 925 296 2124 <br /> Blllobfa Party Sanlec Address 370 North Wigel Ln.Ste.210 City Walnut Cleak Zip 94595 Phone 925 296 2124 <br /> GIS Coordinates:X Y <br /> CONSTRUCTION WORK TO BE PERFORMED: <br /> N NEW WELLIBORING(CPT,GEOPROSE.HYDROPUNCH,HAND-AUGER.OTHER) <br /> 0 SOIL BORING IDs LA3PZ-1.LA3PZ-2,1A3PZ-3 <br /> ❑WELL IDs <br /> ❑OTHER IDP <br /> TYPE&9 O WELVBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> _❑MONITORING O HOLLOW STEM DIA OF BOREHOLE 3'75/4 ❑MULTIPLE CASINGS[I MULT4LEVEL WELL CASINO CIA: <br /> _❑EXTRACTION:Vapor/Water E]HAMMMDRNEN CASING THICKNESS t/8 TYPE OF CASING: [3STEEL ®PVC ❑ OTHER <br /> _O SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TBD TREMIE TYPE TO BE USED: O AUGERS ❑HOSE O PIPE <br /> _®SOIL BORING M PUSH POINT(GPI CPT) GROUT SEAL PUMPED:0 Yes ®No(MAXIMUM FREE FALL DEPTH IS 30 FT) <br /> _C3 INJECTION(I.e Ah Seame.Oxenet❑HAND AUGER GROUT SPECIFICATIONS <br /> —11B OTHER:Temp.Peizomeler ❑OTHER: APPROX.BORING DEPTH O BOLTED TRAFFIC BOX OR ®STOVE PIPE <br /> CONDUCTOR CASING 0 No❑Yes:Casing Dia: Casing Depth:_ Boring Dia:_ <br /> COMMENTS:All Piezometers to be destroyed by over drilling and grouting upon completion of percalatioNmounding study <br /> NOTE: OFFSITE WELLS&BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:fcHECX ALL THAT APPLY) <br /> #OF WELL(S)TO BE DESTROYED ®OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT <br /> WELL IDS: ❑PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE <br /> GROUT SPECIFICATIONS ❑EXPLOSIVES FROM To FT BELOW SURFACE <br /> TREMIE TYPE TO BE USED: AUGERS ❑HOSE 0PIPE ❑MUSHROOM CAP AT L3 FT) FT BELOW SURFACE <br /> COMMENTS All Piezomelers to be destroved by d ilina and arcutino upon completion of oe eola9on/me nd'na study <br /> 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE)FOR INSPECTION APPOINTMENTS <br /> 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 <br /> Regulations,and all <br /> applicable California Laws. <br /> Signed "r (w Title/Company Soil Scientist,Stantec <br /> Print Name ':fames votK Dale 1211812012 <br /> DEPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE SITE ADDRESS 156 ) I-J, (7RCy PKk'N <br /> WORK PLAN DATEDAPPLICATION ACCEPTED ACCEPTED BY DATE IS 1699 <br /> GROUT INSPECTION BY FINAL INSPECTION BY .OIL k DATE 12-zo-I z <br /> DESTRUCTION INSPECTION BY DATE <br /> COMM E NTSICONDITIONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> PE CODES FEEINFO AMTREMITTED CHECK# RECV'D BY DATE SERVICE RD# INVOICE <br /> REQUE//ST PR# <br /> )c)01 $1251 - 3q76 &6Uyw I2•1y-12 SR# toGzQS <br /> 290 3 Ro# <br /> (3$99 <br /> PR# <br /> (2900) <br /> C-57 ri WC L WAVER r.i C57 LETTER OF AUTHORIZATION TO SIGN PERMIT v ENCROACHMENT DOC /v <br />