BILLING/PERMITS_2017-2018 - Laserfiche WebLink

Home Browse Search

SANIOAQ PN Environmel He r t ' COUNTY- --- HE Greotness grows here. IAN ' D 2018 SITE MITIGATION WELL & BORING PERMIT APPLIW"NTALHEALTH For Wells and Borings Used for Contaminant Investigations and Remt PSERMCES NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 48 Hours Advance Notice Required For All Inspections 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 San Joaquin County Well Standards. Job Address 17100 Murphy Parkway City/State/Zip Lathorp,CA,95330 Phone (925)674-8400 Cross Street D'Arcy Parkway APN 198-120-09 Property Owner* Reynolds and Brown,et al Phone (925)674-8400 Address 1200 Concord Avenue,Suite 200 City/State/Zip Concord,CA,94520 C-57 Contractor Penecore Drilling.Inc License# 906899 Phone 530.661.3600 Address 220 N.East Street City/State/Zip Woodland,CA 95776 Consultant/Sub- Contractor Advanced GeoEnvironmental,Inc. License# 680227 Phone 800-511-9300 Address 837 Shaw Road City/State/Zip Stockton,CA 95215 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 10 to 15 feet ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 2-Inch ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ® SOIL BORING 32 ID PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Sparge,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDS ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED [:]AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: I hereby certify that I am authorized to complete this application and that the work will be done in accordance with / San J uin County Ordinance Codes and Standards,and all other applicable California laws, Signed L�qa =, Title/Company Advanced GeoEnvironmental,Inc. Print Name William Little Date 01/10/2018 DEPARTMENT USE ONLY Application Accepted By: J'►" JOiU� Date Issued: A t) Grout Inspection By/Dates: Destruction Inspection By/Dates: Facili /Site Information FA Name FA Address i j M �# t�(7 2 `2 PR# c)S 4Zv1,a-c: FA PE ` WP Reviewed By h ��N"J` Work Plan Date 1 /s�7 �✓ EIC-57 ;%C-57 Authorization for Other to Sign Permit WorkePs Comp [I Worker's Comp Waiver []Encroachment Permit [I Access yqLead Aency Approval MFR COMMENTSICONDITIONS: bre � { �R.� 'WW. 1� V `� WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE r� pWELL PERMIT# INVOICE# W` Permit 175 $152x !>� 2�,�5 °� �r7 00 7,1 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 08-01-17 "& VICAn-� 5; c , , [�j Site Mitigation Well Permit Application