Laserfiche WebLink
PEYOPY <br /> r f. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT LOP <br /> 1868 Hazekon Avenue, Stockton,CA 95205-8232 SITE MITIGATION <br /> x. <br /> Telephone:(209)468-3147 Fax:(209)465-3433 Web:www.siaov.orafehd UNIT IV <br /> WELL & BORING PERMIT APPLICATION <br /> FOR WELLS AND BORINGS USED FOR CONTAMINANT INVESTIGATIONS AND REMEDIATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> Application Is hereby made to San Joaquin County for a pennit to construct andfor install the work described. This application is made in compliance With San <br /> Joaquin County Development Tl le,Chapter&1115.3,and the Standards of the San Joaquin County Environmental Health Department. <br /> Site Location 11900 N Furry Road Cross Street Armstrong CityfSlate Lod),CA Zip 95240 ApN 061-160.26 <br /> Owneerty Goldstone Land Co LLC Address 11900 N Furry Road CiWState Lodi,CA Zip 95240 phone (209)3683113 <br /> C•67 Contractor Woodyard Drilling Address PO Box 336 city/Stale Rwvow.cA Lip 710079 phone (707)374.4300 <br /> Consuitant(Suh Cntr Fail Creeek Enqr Address PO Box 7834 City/State Smw Ouz CA Lic 55605 Phone (831)42S-1440 <br /> BillableParty Bear Creek Winery Address 1 19D N Furry Road City/State Lodi,CA Zip 95240 phone (209)3683113 <br /> GIS Coordinates:X V <br /> CONSTRUCTION WORK TO BE PERFORMED: <br /> 29 NEW W ELUBORING(CPT,GEOPROBE,HYDROPUNCH,HAN0.UGER,OTHER) <br /> ❑SOIL BORING IDs <br /> ®WELL to M 5 M <br /> ❑OTHER IDs <br /> TYPE 3#OF WELLTBORING INSTALLATION TVPE CONSTRUCTION SPECIFICATIONS <br /> MONITORING M HOLLOW STEM DIA,OF BOREHOLE 81nrh 0 MULTIPLE CASINGS O MULTFLEVEL WELL CASING DIA 2 inch <br /> _l]EXTRACTION:Vaporl Water O HAMMERIDRIVEN CASING THICKNESS Seh 40 TYPE OF CASING: 0 STEEL N PVC 0 OTHER <br /> _0 SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL 95 TREMIE TYPE TO BE USED:EI AUGERS O HOSE 0 PIPE <br /> _O SOIL BORING ❑PUSH POINT(GPI CPT) GROUT SEAL PUMPED:M Yes Q No(MAXIMUM FREE FALL DEPTH IS 30 Fn <br /> _I]INJECTION I, Mr So Ozmef 0 HAND AUGER GROUT SPECIFICATIONS Neat Cement <br /> _0 OTHER: O OTHER: APPROX.BORING DEPTH 120 feet 0 BOLTED TRAFFIC BOX OR M STOVE PIPE <br /> CONDUCTOR CASING W No 0 Yes:Casing Did:_Casing D<Plh:_Boring Ou:_,_ <br /> COMMENTS: <br /> NOTE: OFFSITE WELLS&BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS <br /> rTFgTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD-(CHECK ALL 1HATAPPLYI <br /> 5 #OFWELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER OF-INCHES TO DEPTH OF FT <br /> WELL IDs: <br /> MW-1,MW-2 MW-3 MW5 MW-6 ®PRESSURE GROUT TO DEPTH OF 100feet FT BELOW SURFACE <br /> GROUT SPECIFICATIONS ea amen ❑EXPLOSIVES FROM TO FT aELOWSURFACE <br /> __ TR OUT TYPE Tn B-n uSED:.❑A E PIPE ®MUSHROOM CAP AT L3 FT) 3 SFT BELOW SURFACE <br /> COMMENTS <br /> 5 WORKING DAYS NOTICE REQUIRED(AFTER PERMIT ISSUANCE)FOR INSPECTION APPOINTMENTS <br /> I hewby ceAHy Mat 1 have prepared this application that the work will be done in accordance with San Joaquin County Opprdinanttces,Rules and / <br /> Regulation#,and all applleabla Calitorn a GCS 7IiiPJCompany, Civil Engineer �, t�0 D lG 6w(�t^.¢¢✓l <br /> Signed 444 <br /> Pdm Name Frederick A.Y c Date <br /> EPARTMENT USE ONLY <br /> SITE MAP IN UNIT IV FILE-SITE ADDRESS <br /> WORK PLAN DATED <br /> APPLICATION ACCEPTED BY DATE <br /> GROUT FINAL INSPECTION BY <br /> �dPb DATE fid'Zy-GROUT INSPECTION BY <br /> DESTRUCTION INSPECTION BY DATE <br /> COMMENTSICONDITONS: <br /> ACCOUNTING ONLY: AID# FAC# <br /> SERVICE PRO <br /> # INVOICE <br /> PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE REQUEST PR# <br /> Zqo� Sl x 1 I7� Apt, 0 0 0 <br /> R <br /> Two <br /> PR* <br /> 2900 <br /> C-57 WC WAIVER 0.57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT OCL_LL APP <br /> END 29-01 5109112 <br />