COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

� FILE COPY . Aa"I" SAN JOAQUIN COUNTY r `r' ENVIRONMENTAL HEALTH DEPARTMENT LOP 600 East Main.Street, Stockton, CA 95202-3029 SITE MITIGATION c �'P Telephone:(209) 468-3454 Fax:(209)468-3433 Web:www.sigov.org/ehd UNIT IV \q<JFOR 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. Site Location 248 Industrial Cross StreetMcKenna Property City Stockton Zip 95206 APN 177-280-20 Owner Steve Donell,Receiver Address 12121 Wilshire,#1120 City Los Angeles Zip 90025 Phone 310-207-8481 C-57 Contractor V&W Drilling Address 3806 Duck Creek Drive City Stockton Lic 720904 Phone 209-369-3608 .Consultant/Sub CntrPinnacle Environmental,Inc.Address P.O.Box 904 City Clayton Lic 94517 phone 925-673.5500. Billable Party Steve Donell,Receiver Address 12121 Wilshire,#1120 City Los Angeles Zip ano2s Phone 310-207-8481 GIS Coordinates:X 37.90614 Y 121.26967 . CONSTRUCTION WORK TO BE PERFORMED: ®NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) (2 SOIL BORING IDs 4 borings to collect shallow groundwater sample(appro)L 27 feet)with HSA rig El WELL IDs_ 8 borings to install 8 2-inch monitoring wells(MW-1 to MW-8) ❑OTHER IDs TYPE&#OF WELLIBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS 8 ❑MONITORING ®HOLLOW STEM DIA.OF BOREHOLE 8.25' ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: _❑EXTRACTION:Vapor/Water ❑HAMMER/DRIVEN CASING THICKNESS 2-Inch ID TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER _❑SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL -16 feet TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE p PIPE 4 ❑SOIL BORING ❑PUSH POINT(GP/CPT) GROUT SEAL PUMPED:®Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) _❑INJECTION(i.e.AJrSDarae.Ozone)❑HAND AUGER GROUT SPECIFICATIONS neat cement _❑OTHER: ❑OTHER: APPROX.BORING DEPTH 35 feet p BOLTED TRAFFIC BOX OR ❑STOVE PIPE CONDUCTOR CASING M No❑Yes:Casing Dia: Casing Depth: Boring Dia: COMMENTS: 4 borings to be abanondoned same day as completion. 8 borings to be converted to 2-inch monitoring wells. NOTE: OFFSITE WELLS&BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #OF WELL(S)TO BE DESTROYED ❑OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT WELL IDs: ❑PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE GROUT SPECIFICATIONS ❑EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED:❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP AT L3 FT) FT BELOW SURFACE COMMENTS 4 temporary monitoring wells for grab groundwater samples to be closed the same day 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby cSoify1ftaKhave prepared this application and that the work will be done in accordance with San Joaquin County Ordinances,Rules and Regula' ns,and all li li Laws. Signe Title/Company Principal/Pinnacle Environmental Inc. Print Name P ter K. oven Date 5.17.2013 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE SITE ADDRESS Z yg 1Vbct3rer64. /�Ql WORK PLAN DATED A rizi L / APPLICATION ACCEPTED BY l.+ DATE 1 EA GROUT INSPECTION BY FINAL INSPECTION BY DATES 0-�3 DESTRUCTION INSPECTION BY DATE .r COMMENTS/CONDITIONS: F;\j I ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BYDATE SERVICE RO# INVOICE REQUEST I PR# 01901 $125 x 8 Co4/62(, �LEer 5.20-� SR# � o ,z; (300 G�z3y Al a� 3,-- PR# (2900 C-57_� WC _WAIVER C57 LETTER OF AUTHORIZATION TO SIGN PERMIT / ENCROACHMENT DOC ,R24