Laserfiche WebLink
Signed <br />Print Name Chris Drabandt <br />Title/Company Project Geologist / ECM, Inc. <br />Date <br /> 6/23/2015 <br />SITE MAP IN UNIT IV FILE - SITE ADDRESS <br />WORK PLAN DATED & )/5—/ <br />APPLICATION ACCEPTED BY MAAAAcci DATE I SSGED AREA -- <br />GROUT INSPECTION BY /7,---4,6 --- ----=-;--..-5 FINAL INSPECTION BY,..<74. 4-;-4,4t44---- DATE <br />_...--:::--------7' <br />7 <br />DESTRUCTION INSPECTION Y //-17/ 1,4A (-16 _ • r , <br />COMMENTS/CONDITIONS: FT) (A ) ,-f" ;31-( Li -he rtinv <br />DEPARTMENT USE ONLY <br />g0 10 5. 01.4 r „-,A- <br />ri it tl L) <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3147 Fax: (209) 468-3433 Web: www.sicjov.orq/ehd <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 permit to construct and/or install the work described. This application is made in compliance with San <br />Joaquin County Development Title, Chapter 9-1115.3, and the Standards of the San Joaquin County Environmental Health Department. <br />JUN 24 2015 <br />ENVIRONMENTh,LOP <br />PEptArris:Wrg_FITIGATioN <br />Iv <br />8010 S. Airport Way Site Location <br />Property CA Army National Guard <br />Owner <br />C-57 Contractor Penecore Drilling <br />Consultant/Sub Cntr ECM, Inc. <br />Billable party CA Army National Guard <br />GIS Coordinates: X -121.247 <br />Cross Street <br />Address <br />Address <br />Address <br />Stimson Street Stockton, CA . 95206 City/State Zip APN 17726004 <br />10260 Mather Blvd. City/State Mather, CA zip 95655 Phone 916-369-4375 <br />220 N. East Street City/State Woodland, CALic #906899 Phone 530-661-3600 <br />3525 Hyland Ave., Suite 200 City/StateCosta Mesa, CALic #778024 Phone 714-662-2759 <br />Address 10260 Mather Blvd. City/State Mather, CA zip 95655 <br /> <br /> Phone 916-369-4375 <br />37.8848 <br />CONSTRUCTION WORK TO BE PERFORMED: <br />NI NEW WELL/BORING (CPT, GEOPROBE, HYDROPUNCH, HAND-AUGER, OTHER) <br />D SOIL BORING IDs <br />LI WELL IDs <br />[3] OTHER IDs 28 DPT ISCO injections and 1 SB in 3 total mobilizations. 5 DPT injection points and one soil boring will be advanced through concrete slab (Si 10-12 feet bqs. <br />TYPE & # OF WELL/BORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />0 MONITORING NJ HOLLOW STEM DIA. OF BOREHOLE 3"-6" 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA: <br />0 EXTRACTION: Vapor/ Water 0 HAMMER/DRIVEN CASING THICKNESS 2" TYPE OF CASING: 0 STEEL Di) PVC 0 OTHER <br />0 SOIL VAPOR PROBE 0 MUD ROTARY DEPTH OF GROUT SEAL N/A TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE 0 PIPE <br />1 DI] SOIL BORING PUSH POINT (GP/ CPT) GROUT SEAL PUMPED: 0 Yes 0 No (MAXIMUM FREE FALL DEPTH IS 30 FT) <br />Boreholes will be abandoned with neat cement after completion of injections 28 IpJECTION (i.e .Air Soaroe. Ozone) 0 HAND AUGER GROUT SPECIFICATIONS <br />OTHER: 0 OTHER: APPROX. BORING DEPTH no greater than 55 feet 0 BOLTED TRAFFIC BOX OR 0 STOVE PIPE <br />CONDUCTOR CASING 0 No 0 Yes: Casing Dia: Casing Depth: Boring Dia: <br />COMMENTS: First mobilization planned for 6/30/15 for soil boring and punch through concrete slab, injections to begin week of 7/6/15 and second set of injections 8/10/15. <br />NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS <br />DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br /># OF WELL(s) To BE DESTROYED 0 OVER-BORE DIAMETER OF INCHES TO DEPTH OF FT <br />WELL IDs: 0 PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE <br />GROUT SPECIFICATIONS El EXPLOSIVES FROM TO FT BELOW SURFACE <br />El MUSHROOM CAP AT (.,3 FT) FT BELOW SURFACE <br />COMMENTS <br />TREMIE TYPE TO BE USED: El AUGERS El HOSE LI PIPE <br />5 WORKING DAYS NOTICE REQUIRED (AFTER PERMIT ISSUANCE) FOR INSPECTION APPOINTMENTS <br />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 <br />Regulations, and al applicable California laws. <br />ACCOUNTING ONLY: AID # <br />if <br />FAC # <br />PE CODES FEE INFO AMT REMITTED CHECK # RECV'D BY DATE SERVICE <br />REQUEST <br />RO # <br />PR # INVOICE <br />c2. ct 0 5- $1c4, 3 li 310 • - -2.-0 16<r W bfr..-10.- sR# <br />X9 c73 4 340 -tr 310 - - ,‘ <br />e.c.ozz601 5R -4-2.C5-(1 - . ; <br />(2900) <br />C-57 N- WC WAIVER <br />EHD 29-01 5/09/12 <br /> <br />C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT <br />FA 001 8 32.3 <br /> <br />ENCROACHMENT DOC <br />WELL PERMIT APP <br />