FIELD DOCUMENTS_2008-2015 - Laserfiche WebLink

Home Browse Search

IRA PIA �► • r.. qgl"' SAN JOAQUIN COUNTY it 'I ��.... Ll ENVIRONMENTAL HEALTH DEPARTMENT LOP I 1868 Hazelton Avenue, Stockton, CA 95205-6232 SITE MITIGATION Telephone:(209)468-3147 Fax:(209)468-3433 Web:vw vv-sigov.oraleh UNIT IV 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 6455 Pacific Ave Cross Street West Benjamin Hol[ 9741029 Property City/State Stockton,CA Zip 95207 APND Owner r,mam^ ..ucv,L„,,+.ne,,,,,a,.ra..,a..,.., Address 2500 Ventura Oaks Way City/State annnoree-,cA Zip 9533_ 3 Phone 916-646-8211 C-57Contractor National E.W.P Address 1961 Meeker Ave City/State Richmond,CA Lic 953646 Phone 510-236-6262 Consultant/Sub Cntr Address City/State T—Lic__T Phone Billable Party Geosyntec Consultants Address 3042 Gold Canal Drive Suite 201 City/State "'"`°°"°^^`" Zip 96670 Phone 916-637-8048 GIS Coordinates:X 121.321172°W y 38.008905°N T/ —iz�zy CONSTRUCTION WORK TO BE PERFORMED• ❑NEW WELL/BORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER) El SOIL BORING IDs ❑WELL IDs ❑OTHER IDs - TYPE&#OF WELLIBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑MONITORING ❑HOLLOW STEM DIA OF BOREHOLE_ ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA:_ _O EXTRACTION:Vapor/Water ❑HAMMERIDRNEN CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER _[I SOIL VAPOR PROBE ❑MUD ROTARY DEPTH OF GROUT SEAL TREMIE TYPE TO BE USED: 11 AUGERS ❑HOSE ❑PIPE —0 SOIL BORING ❑PUSH POINT(GPI CPT) GROUT SEAL PUMPED:❑Yes ❑No(MAXIMUM FREE FALL DEPTH IS 30 FT) —O INJECTION(La Ar Soaree.Ozone)❑HAND AUGER GROUT SPECIFICATIONS _O OTHER: ❑OTHER: APPROX.BORING DEPTH ❑BOLTED TRAFFIC BOX OR ❑STOVE PIPE COMMENTS: CONDUCTOR CASING❑No Q Yes:Casing Dia:_Casing Depth:_ Boring Die:_ NOTE: OFFSITE WELLS& BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:ICHECK ALL THAT APPLY) #OF WELL(S)TO BE DESTROYED 0 OVER-BORE DIAMETER OF Sr-TW. INCHES TO DEPTH OF See Table FT WELL IDs: SVE-033 and SVE-032 ❑i PRESSURE GROUT TO DEPTH OF sea Tebla FT BELOW SURFACE GROUT SPECIFICATIONS Neal Cament(94 lb beg/6.6 gallon,water ❑EXPLD$VE$FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED:O AUGERS ❑HOSE ❑PIPE A MUSHROOM CAP AT(>3 FT) 3 F7 BELOW SURFACE COMMENTS Tables,figures access agreement and data for pressure grouting attached 5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Rules and Regulations,a all applicable California laws. / Signed � .�, G-�-L, Title/Company Project Geologist 167 Sy-117r Print Name Timothy Davis Date 8/22/2014 �q EPARTMENT USE ONLY SITE MAP IN UNIT IV FILE-SITEADDRESS ht I l e IIL /(/ //434r . -57gllonb WORK PLAN DATED a.7 L{ /y APPLICATION ACCEPTED BY - IOgni P4 DATEISSUEDAREA �� 49 GROUT INSPECTION BY FINAL INSPECTION BY DATE DESTRUCTION INSPECTION BY DATE COMM ENTS/C ONDITI ONS: ACCOUNTING ONLY: AID# FAC# PE CODES R AMT REMITTED CHECK# RECV'D BY DATE SERVICE Rot # INVOICE REQUEST PR# 02A40 2233 2 �bavT> Q v'Z2ly SR#607038 X103 3Yo RO# 3500 PR# (2900) C-57 WCy WAIVER 0-57 LETTER OF AUTHORIZATION TO SIGN PERMIT L/ ENCROACHMENT DOC�/9^ END 29-01 7/24/14 _ WELL PERMIT APP