WORK PLANS - Laserfiche WebLink

Home Browse Search

SAN .JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT LOP 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION • ;.-� -:N;'. UNIT IV Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: www.sigov.org/ehd �/FOR 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. City of Stockton ROW Adjacent to 308 S E1Dorado St. Site Location Cross Street Lafayette and El Dorado. City/State CA Zip 95203 APN City ROW Property Owner City of Stockton Address 425 N. E1 Dorado City/State Stockton Zip 95202 Phone 209-937-8366 C-57 Contractor All Well Abandonment Address 9245 Beatty Drive Suite A City/State Sacramento LIC 848359 Phone 916-363-9355 Advanced Geo Environmental Inc. 837Shaw Road Stockton 680227 209-467-1006 Consultant/Sub Cntr Address City/State Lic Phone Billable Party Den Ueda Address 626 East Galin Road City/State French campZip 95231 Phone 209-462-1262 GIS Coordinates:X Y CONSTRUCTION WORK TO BE PERFORMED: ❑NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) ❑SOIL BORING IDS ❑WELL IDS ❑OTHER IDs TYPE&#OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ©HOLLOW STEM DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor!Water ❑HAMMERIDRIVEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER _0 SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: ❑AUGERS in HOSE ®PIPE _❑SOIL BORING ❑PUSH POINT(GP(CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) _❑INJECTION(i.e.Air Sparge,Ozone)❑HAND AUGER GROUT SPECIFICATIONS _❑OTHER: ❑OTHER: APPROX.BORING DEPTH ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING❑No❑Yes:Casing Dia: Casing Depth: Boring Dia: COMMENTS: NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) 65 and 120 #OF WELL(S)TO BE DESTROYED EI OVER-BORE DIAMETER OF s INCHES TO DEPTH OF FT VOELL IDS: Mw-8, MW-9 and MW-10 ©PRESSURE GROUT TO DEPTH OF 65 FT BELOW SURFACE GROUT SPECIFICATIONS Portland Type I II ❑EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED:[D AUGERS ®HOSE El PIPE El MUSHROOM CAP AT(>3 FT) 3 FT BELOW SURFACE COMMENTS 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby ceJandd I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulatio s, applicable California laws. Signed Title/Company Project Geologist Print Name Daniel Villanueva Date 05/13/2013 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITE ADDRESS 33P 'S, E4. �o?i7Da Si ri- Smcfer' xi YT WORK PLAN DATED PRI L. 2q. 2-c'/'3 APPLICATION ACCEPTED BY J , *16 xt4n DATE ISSUED 5•/S"-/ ii AREA-h6-2-9 GROUT INSPECTION BY FINAL INSPECTION BY DATE DESTRUCTION INSPECTION BY DATE COMMENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE SERVICE RO# INVOICE REQUEST PR# '35,0 2• $ 125x 3 — (, d d°Cgl-"� R SX -t SR* ?l4 Z 35d RO# (3500) PR# _ 2900) C-57�_ WC WAIVER -__L_1/r r C 57 LETTER OF AUTHORIZATION 1.0 SIGN PERMIT _2 ,ENCROACHMENT DOC 14 FHn 79-01 5/nwi? WPI I PFR4,4IT App