BILLING/PERMITS_2017-2018 - Laserfiche WebLink

Home Browse Search

RECEIVED SAN JOAQUIN COUNTY � DEC 0 4 2017 ENVIRONMENTAL HEALTH DEPARTMEt�tRDNrAL LOP { 1868 Hazelton Avenue, Stockton, CA 95205-6232 PERMIT/SERIACC UNIT IV c •.-� .•:P Telephone: 209 468-3147 Fax: 209 468-3433 Web: www.sigov.orp/ehd 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 17100 Murphy Parkway Cross Street D'Arcy Parkway City/State Lathrop, CA Zip 95330 APN 198-012-009 Property Owner ASP/RWM Properties, et al Address 1200 Concord Ave. Ste. 200 City/State Concord/CA Zip 94520 Phone (925) 674-8400 C-57 Contractor Cascade Drilling Address 3000 Duluth Street City/State West Sac., CAJC 938110 Phone (916) 638-1169 Consultant/Sub Cntr Brusca Assoc., Inc. Address PO Box 332 City/State Roseville, CALic CEG#1948 Phone (916) 677-1470 Billable Party Brusca Assoc., Inc. Address PO Box 332 City/State Roseville, CAZip 95661 Phone (916) 677-1470 GIS Coordinates: X 37.806 Y -121.287 OR v.Sck Assoc. --TIYG • ::1s 9E -F -for -t S-7BLE ft;)iZ C(4, 646 ZE&a—(:c� -Co-- tx✓EU P F --Tu zv • � G- A PF -W 1 i1 7 y G- o N L -f. CONSTRUCTION WORK TO BE PERFORMED: ❑ NEW WELL/BORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER) ❑ SOIL BORING IDs ❑ WELL IDs SGMVV1 and 6(3MVV2 ❑ OTHER IDs TYPE & # OF WELUBORING INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS _❑ MONITORING 121 HOLLOW STEM DIA. OF BOREHOLE 8 ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA: _❑ EXTRACTION: Vapor/ Water ❑ HAMMER/DRIVEN CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER _❑ SOIL VAPOR PROBE ❑ MUD ROTARY DEPTH OF GROUT SEAL 2' TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE _❑ SOIL BORING ❑ PUSH POINT (GP/ CPT) GROUT SEAL PUMPED: ❑ Yes ❑ No (MAXIMUM FREE FALL DEPTH IS 30 FT) _❑ INJECTION (i.e.AirSoaroe.Ozone) ❑ HAND AUGER GROUT SPECIFICATIONS neat cement grout 2 ffOTHER: Soli Gas Monitoring weir ❑ OTHER: APPROX. BORING DEPTH 10, ❑ BOLTED TRAFFIC BOX OR ❑ STOVE PIPE CONDUCTOR CASING ❑ No ❑ Yes: Casing Dia: CasinDepth: Boring Dia: COMMENTS: Installation of 2 soil gas monitoring wells and abandonment of existing well per 8/10/17 Workplan an /7/17�dden d m NOTE: OFFSITE WELLS & BORINGS REQUIRE ACCESS AGREEMENTS OR ENCROACHMENT PERMITS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) 1 # OF WELL(S) TO BE DESTROYED ® OVER -BORE DIAMETER OF S, NCHES TO DEPTH OF 20 FT WELL IDs: VF`1 ❑ PRESSURE GROUT TO DEPTH OF FT BELOW SURFACE GROUT SPECIFICATIONS ❑ EXPLOSIVES FROM TO FT BELOW SURFACE TREMIE TYPE TO BE USED: ® AUGERS Q HOSE ❑ PIPE ❑ MUSHROOM CAP AT L3 FT) FT BELOW SURFACE COMMENTS Abandonment of existing soil gas monitoring well 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, hd all applicable California laws. Signed k I v"ut^z_ Title/Company President / Brusca Associates. Inc. Print Name oe rusca Date 11/27/17 DEPARTMENT USE ONLY SITE MAP I IT IV FILE - SITE A DRESS WORK PLAN DATED APPLICATION ACCEPTED BY /0-4,h-4 DATE ISSUED Zl IS /) •7 AREA GROUT INSPECTION BY 1--- X S6 - M%.i I . S I:r r4,Vj 2- IV I Lit FINAL INSPECTION BY DATE DESTRUCTION INSPECTION BY L, . -A ✓PI 1111,611,9 DATE 1 COMMENTS/CONDITIONS: WQ<•A- 6L S{ o (l�� `�'y: LCA f� � `1i� -Z ACCOUNTING ONLY: AID # C G '� 5"110 FAC # as Z 79 PE CODES FEE INFO AMT REMITTED CHECK # RECV'D BY DATE SERVICE I RO # PR # INVOICE ` (�REQUEST k.M, 17—/LA SR#ocl 7%.313 7 (WOO 07 PR #U)O C-57 WC WAIVER C-57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC EHD 29-01 5/09/12 WELL PERMIT APP