COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

EXTRACTION (Vapor/Water) 0 HAMMER/DRIVEN (6) co SOIL VAPOR PROBE 3 (a) 1:1 MUD ROTARY IE SOIL BORING 5(b) El PUSH POINT (GP/CPT) INJECTION (Air Same. Ozone) 0 HAND AUGER (b) El OTHER 0 OTHER: SV- WELU SOIL BORING IDs (a) 1 Thru SV-3 (b) \\-N - DESTRUCTION WORK TO BE PERFORMED: # WELLS TO BE DESTROYED DESTRUCTION METHOD: (CHECK ALL THAT APPLY) El OVER-BORE DIAMETER of inches to depth of feet PRESSURE GROUT To depth of feet below surface EXPLOSIVES From to feet below surface MUSHROOM CAP 0 3 feet below surface or feet below surface if >3 feet WELL IDs GROUT SPECIFICATIONS TREMIE TYPE TO BE USED 0 AUGERS 0 HOSE 0 PIPE COMMENTS: I hereby certify that I arci auth / San Joaciin_,p_satnt / \ Signed Print NameGregory Stahl ized to complete this application and that the work will be done in accordance with nance Codes and Standards, and all other applicable California laws. Title/Company VP / Ground Zero Analysis, Inc. Date 8/9/17 _ EPARTMENT USE ONLY Application Accepted By: Grout Inspection By/Dates: L x ethcio i-Lickt) t t-3). Date Issued: 5// Destruction Inspection By/Dates. Facility/Site Information .sjce OM cation SAN 1OAQA Environmeb_al Health Department —COUNTY CI x L1J r..... ,'ss 9r -c"= >= CV j?IrLu E MITIGATION WELL & BORING PERMIT APPLICATION ill ft CV CV I E-:Wells and Borings Used for Contaminant Investigations and Remediation Ci, NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED (...0 :7.) 0 48 Hours Advance Notice Required For All Inspections Ill -.z re w 2 Rpplication is hereby made to San Joaquin County for a permit to construct and/or install the work described. Teepplication itnade in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. Job Address 1245W. Charter Way City/State/Zip Stockton, CA 95206 Phone Cross Street S. Fresno Street APN 163-230-34 Property Owner* Geo Properties, Inc. Phone 209-848-3272 Address 2306 Jackie Court City/State/Zip Oakdale, CA 95361 C-57 Contractor TEG License# 706568 Phone 916-853-8010 Address 11350 Monier Park Place City/State/Zip Rancho Cordova, CA 95742 Consultant/Sub-Contractor Ground Zero Analysis,Inc. License# 5023 Phone 209-522-4119 Address 1172 Kansas Avenue City/State/Zip Modesto, CA 95351 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits [2:1 BOLTED TRAFFIC BOX 0 STOVE PIPE 0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA. OF BOREHOLE) k-51 (b )3 DIA CASING THICKNESS TYPE OF CASING: D STEEL 0 PVC OTHER CONDUCTOR CASING 0 Yes El No Boring Dia: q) j. S " Casing Dia: ck " Casing Depth: GROUT SEAL DEPTH TREMIE TYPE TO BE USED: 0 AUGERS 0 HOSE 0 PIPE GROUT SEAL PUMPED? 0 Yes 1:8:1 No (Note: Maximum Freefall Depth is 30 Ft) Soil vapor probes & hand auger borings will be destroyed upon sample collection SPECIFICATIONS and filled with grout INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS HOLLOW STEM BORING DEPTH ak) S . (1:,) GROUT (a) 5' TYPE OF WELL/BORING NUMBER ID MONITORING FA Name r ( &71, FA Address / z...&,..c ,j , (Li ic,/ 1,1 FA# 0-0 2,3 V PR# FA PE WP eviewed By rv---- Work Plan Date 6/ I 1: . / 7 i 7/ 1136 0 C-57 Authorization for Other to Sign Permit orkers Comp 0 Workers Comp Waiver 0 Encroachment Permit 0 Access Agreement 2'Lead Agency Appr val UMFR COMMENTS/CONDITIONS: 6'rivk )^Al'A SC )D d— 1A...•34" C-ekv,111.4 NJ") , WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 4 250--- $152x .3 4.'"Cg 3073 2- 0.-"- 9/) 3 1.1P 0-03'7o9 /01868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-34264 F 209 464-0138 I #4 EHD 29%4-05 4 Oiteeitt'