WP0039470 - Laserfiche WebLink

Home Browse Search

SAN.%)QQQUIN Environmental Health Department COUNTY �CgCfFG��,P G.'a,7tr1?SS q^0,,VS he,r-. SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings Used for Contaminant Investigations and Remediation NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 48 Hours Advance Notice Required For All Inspections 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 San Joaquin County Well Standards. Job Address F Street South of Waterloo City/State/Zip Stockton,CA Phone Cross Street Sierra Lane APN DC-GB 0005 Property Owner* PG&E/Brigette Hernandez Phone 916-244-3269 Address 6121 Bollinger Canyon Road City/State/Zip San Ramon,CA 94583 C-57 Contractor Cascade Drilling LLP License# 938110 Phone 916-638-1169 Address 3000 Duluth Street City/State/Zip West Sacramento,CA 95691 Consultant/Sub-Contractor Barnard Pipeline License# Phone 530-669-5810 Address 21 Pioneer Ave City/State/Zip Woodland,CA 95776 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 200' EI BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 8" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS 2:SCH 40 TYPE OF CASIN : ❑STEEL ®PVC ❑QTHER [ISOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ElYes M No Boring Dia brr Casing Dia: L�f Casing Depth: 'LOO' ❑ INJECTION(Air Soarae,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE El PIPE ® OTHER Cathodic Protection ® OTHER: Sonic GROUT SEAL PUMPED? M Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs GROUT SPECIFICATIONS Neat Cement DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY1 #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDs []PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ElAUGERS [:]HOSE [IPIPE E-1MUSHROOM CAP [__13 feet below surface or feet below surface if>3 feet COMMENTS: I hereby certify that I am authorized to complete this application and that the work will be done In accordance with San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed�� /�� Title/Company V.P Operations/Cascade Drilling Print Name Ralph McGahey Date 3/15/2019 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facili /Site Information FA Name FA Address FA# PR# FA PE WP Reviewed By Work Plan Date ❑C-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR COMMENTS/CONDITIONS: WP TYPE PE sC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit $152 x 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 2M1 08-01-17 Site Mitigation Well Permit Application