ARCHIVED REPORTS_2010_22 - Laserfiche WebLink

Home Browse Search

�o�a�tfr 0 SAN JOAQUIN COUNTY C8%SF4_NV1R0NMENTAL HEALTH DEPARTMENT SITE ' A 600 East Main Street, Stockton, CA 95202-3029 MITIGATION N 0 8,?��hone . : 209 468-3454 Fax: 209 468-3433 Web:www.s'gov.org/ehd UNIT IV �1FOR••` ENVIR001MENT HEALTH WELL PERMIT APPLICATION pERMIT/SERVICES 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 San Joaquin County Environmental Health Department. Assessor's Well Location 27011 S Austin Road Cross Street Burnham Road City Ripon Zip 95366 Parcel# 181-16-7 Property Owner Brocd'ini Farms,Inc. Address 27011S.Austin Road City Ripon Zip 95366 Phone# 209-465-8712 C-57 Contractor Precision Sampling,Inc. Address 2365 Wigwam Drive City Stockton Zip 95205 LIC# 636387 Phone Consultant/Sub Cntr Herst&Associates,Inc. Address 4630 South Hwy 94-North Outer Road City Saint Charles,MO LIC# Phone 636-939-9111 GIS Coordinates:X 2148144.43 Y 6366977.10 Township 1N Range 7E Section 35 WORK TO BE PERFORMED: ®NEW WELLIBORING(CPT,GEOPROBE,HYDROPUNCH,HAND-AUGER,OTHER-) ❑DESTRUCTION(CHOOSE TYPE BELOW) ❑SOIL BORING# ❑OVER-BORE DIAMETER ®WELL# AMW-30 ❑PRESSURE GROUT ❑*OTHER GROUT SPECIFICATIONS ❑EXPLOSIVES DETONATING CARD COMMENTS: TYPE OF WELL INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ®MONITORING ❑HOLLOW STEM DIA.OF BOREHOLE 8 inch ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA: 2 inch ❑EXTRACTION ❑AIR HAMMER/DRIVEN CASING THICKNESS Sch 80 TYPE OF CASING:❑STEEL ®PVC ❑ OTHER ❑VAPOR 0 MUD ROTARY DEPTH OF GROUT SEAL 0-124 feet TREMIE TYPE TO BE USED❑AUGERS©HOSE ❑AIR SPARGE/OZONE ❑PUSH POINT(GP OR CPT)_GROUT SEAL PUMPED:E Yes ❑No (NOTE:MAXIMUM FREE-FALL DEPTH IS 30') ❑SOIL BORING ❑HAND AUGER GROUT SPECIFICATIONS 6 x94#Portland Cement&Max 5%Bentonite&100 gal water ❑OTHER: ❑OTHER: APPROX.BORING DEPTH 150 feet ❑BOLTED TRAFFIC BOX OR ®STOVE PIPE CONDUCTOR CASING PROPOSED (if YES,list specifications in comment section) COMMENTS: NOTE: OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS 48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS I hereby certify that I have pre re this ap !cation and that the work will be done I accordance with San Joaquin County Ordinances,Rules and Regulations,and all appli C for ' aws. Signed Title/Company Manager-Remedial Services/Herst&Associates,Inc. Print Name William J.Abernathy Date January 6,2010 DEPARTMENT USE ONLY SITE MAP IN UNIT IV FILE,ADDRESS: WORK PLAN DATED: or APPLICATION ACCEPTED B DATE ISSUED l—I Z_-I LL AREA GROUT INSPECTION BY., FINAL INSPECTION BY DATE DESTRUCTION INSPECTION DATE COMMENTS/CONDITIONS: ACCOUNTING ONLY: AID# FAC# PE CODES FEE INFO AMT REMITTED CHECK# RECV'D BY DATE PERMIT/SERVICE# INVOICE 41 7q S q I Y01SR#59 C-57 WC -WAIVER C57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC EHD 29-01 10/28/09 WELL PERMIT APP