Laserfiche WebLink
,oQgUVl(�. �o SAN JOAQUIN COUNTY <br />Q' A ENVIRONMENTAL HEALTH DEPARTMENT SITE <br />600 East Main Street, Stockton, CA 95202-3029 MITIGATION <br />Telephone: (209) 468-3449 Fax: (209) 468-3433 Web: www.sj oq v orq/ehd pAy&lffW IV <br />n GEro rrn <br />WELL PERMIT APPLICATION APR 0 2 2009 <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />�OAQLIIN COUNTY <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. This application is, - San <br />Joaquin County Development Title, chapter 9-1115.3 and the Standards of San Joaquin County Environmental Health Department. <br />Assessor's <br />Well Location 9999 South Austin Rd Cross Street Newcastle Road City Manteca Zip 95336 Parcel # 201-06-5 <br />Property <br />Owner Forward, Inc. Address 9999 South Austin Road City Manteca zip 95336 Phone # 209-9824298 <br />C-57 Contractor Precision Sampling, Inc. Address 2365 Wigwam Drive City Stockton Lic # 636387 Phone 209-465-8712 <br />Consultant/Sub CntrHerst & Associates Address4630 S. Hwy 94-N. Outer Road City St. Charles, MO Lic # Phone 636-939-9111 <br />GIS Coordinates: X 6361695 , Y 2144885 -Township 1 South Range 7 East Section 3 <br />WORK TO BE PERFORMED: <br />® NEW WELUBORING (CPT, GEOPROBE, HYDROPUNCH, HAND -AUGER, OTHER') ❑ DESTRUCTION (CHOOSE TYPE BELOW) <br />❑ SOIL BORING# ❑ OVER -BORE DIAMETER <br />® WELL # EW -4 ❑ PRESSURE GROUT <br />El *OTHER GROUT SPECIFICATIONS <br />TYPE OF WELL <br />INSTALLATION TYPE <br />CONSTRUCTION SPECIFICATIONS <br />❑ MONITORING <br />❑ HOLLOW STEM <br />DIA. OF BOREHOLE 13 Inch ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA: 8 Inch <br />91 EXTRACTION <br />❑ AIR HAMMER/DRIVEN <br />CASING THICKNESS SCh 80 TYPE OF CASING: IN STEEL 91 PVC ❑ OTHER <br />❑ VAPOR <br />® MUD ROTARY <br />DEPTH OF GROUT SEAL 0-90 ft TREMIE TYPE TO BE USED ❑ AUGERS ❑ HOSE <br />❑ AIR SPARGE/OZONE <br />❑ PUSH POINT (GP OR CPT)_ <br />GROUT SEAL PUMPED: ® Yes ❑ No (NOTE: MAXIMUM FREE -FALL DEPTH IS 30') <br />❑ SOIL BORING <br />❑ HAND AUGER <br />GROUT SPECIFICATIONS 5 x 94# Portland cement mixed with 100 gallons of water <br />❑ OTHER: <br />❑ OTHER: <br />APPROX. BORING DEPTH 125 feet ❑ BOLTED TRAFFIC BOX OR ® STOVE PIPE <br />CONDUCTOR CASING PROPOSED (if YES, list specifications in comment section) <br />COMMENTS: <br />NOTE: <br />OFFSITE BORINGS REQUIRE ACCESS AGREEMENT OR ENCROACHMENT PERMITS <br />I hereby certify that I <br />Regulations, and aly <br />Signed <br />Print Name William <br />SITE MAP IN UNIT IV FILE, ADDRESS: <br />WORK PLAN DATED: <br />APPLICATION ACCEPTED BY <br />GROUT INSPECTION BY <br />DESTRUCTION INSPECTION BY <br />COMMENTS/CONDITIONS: <br />48 WORKING HOURS NOTICE REQUIRED FOR INSPECTIONS <br />and that the work will be done I accordance with San Joaquin County Ordinances, Rules and <br />Title/Company Manager -Remedial Services/Herst & Associates, Inc. <br />DEPARTMENT USE ONLY <br />Date 3/31/2009 <br />DATEISSUED <br />FINAL INSPECTION BY <br />AREA <br />DATE <br />ACCOUNTING ONLY: <br />AID # <br />FAC # <br />PE CODES <br />FEE INFO <br />AMT REMITTED <br />CHECK # <br />RECV'D BY <br />DATE <br />PERMIT/SERVICE # <br />INVOICE <br />Etlek`w <br />a' <br />20 9 <br />2 01 <br />SR# d,( <br />C-57 WC <br />EHD 29-01 11/5/07 (WEB) <br />-WAIVER C57 LETTER OF AUTHORIZATION TO SIGN PERMIT ENCROACHMENT DOC <br />WELL PERMIT APP <br />