WORK PLANS - Laserfiche WebLink

Home Browse Search

' e <' SAN`JOAQUIN Environmental Health Department �\ COUNTY `'"�+Foa� Greatness grows here. SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Advance Notice Required For All Inspections CALL (209) 953-7697 For 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 �'l�'+ orton Rd. City/State/Zip Lodi. CA.95242 Phone N/A Cross Street N Cord Rd. APNC6513016 Property Owner* City of Lodi White Slough Water Pollution Control Facility Phone (209)333-6749 Address 12751 N. Thornton Road City/State/Zip Lodi. CA. 95242 C-57 Contractor Confluence Technical Services. Inc License# 1035255 Phone (9161 760-7641 Address 6821 8th St. City/State/Zip _Rio Linda. CA 95673 Cons ultant/Sub-Contractor Clav Sorensen/West Yost Associates License# CHG#1108 Phone (925)949-5817 Address 2235 Mercury Way. Suite 105 City/State/Zip Santa Rosa. CA. 95407 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS N/A ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE EXTRACTION(VaporMater) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOILVAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER M SOIL BORING 91 PUSH POINT(GPI CPT) CONDUCTOR CASING @ Yes [3 No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air soarae.Ozone) ❑ HANDAUGER GROUT SEAL DEPTH TREMIETYPETO BE USED: ❑AUGERS ❑HOSE 14 PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? 91 Yes ®No (Note:Maximuryp Freefall Depth is 30 Ft) WELD SOIL BORING IDS GROUT SPECIFICATIONS Iy La 1 4.uy,D.W` DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED 1 AVER-BORE DIAMETER of 8 25_inches to depth of 20 feet WELL IDs WSM-2 PRESSURE GROUT To depth of N/A feet below surface GROUT SPECIFICATIONS 3-5%Bentonite clay,e-10 gallons of poteble water per sack of Pardend cement L]EXPLOSIVES From N/A to N/A feet below surface TREMIE TYPE TO BE USED [D AUGERS ❑HOSE ❑PIPE r MUSHROOM CAP ❑3 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 / 7 —Title/Company Senior Hvdroaeoloaist/West Yost Print Na a Clay Sorensen Date 10/22/2025 DEPARTMENT USE ONLY ++ / Application Accepted By: Date Issued: t 1 2 >! Grout Inspection By/Dates: L�� b/61174 Destruction Inspection By/Dates: Facili /Site Information FA Name ��,L 1 , w L FA Address `Z'�j L �t �Z� FA# PR# FA PE WP Reviewed By Work Plan Date 1 t Il 7 57 ❑C-57 Authorization for Other to Sign Permit ❑Workers Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement 4 Lead Agency Approval MFR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT RE�hMI ED CHECK# RECV-P BY DATE / WELL PERMIT# INVOICE# Permit Z� ✓� �7( 3 $179x i� "l ,tll1 G) WP25013� 1868 E. Hazelton Avenue I Stockton. California 952051 T 209468-34201 F 209 464-0138 1 www.sjcehd.com EHD 29-01 07-01-2025 , it 6 k l[ jYt Site Mitigation Well Permit Application