WP0043774 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN i ii, COU NTY--- Grootness grows here, Environmental Health Department SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Advance Notice Required For All Inspections CALL (209) 953-7697 For 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 Rough and Ready Island Cross Street W Fyffe Street Property Owner* Port of Stockton Address 2201 Washington Street C-57 Contractor PeneCore Drilling Address 220 N East St ConsultantlSub-Contractor Geosyntec consultants Inc Address 3043 Gold Canal Drive, Suite #100 City/State/Zip Stockton, CA 95203 Phone APN 16203007 Phone (209) 946-0246 City/State/Zip Stockton, CA 95203 License# 906899 Phone (530) 661-3600 City/State/Zip Woodland, CA 95776 LicPhone 916-637-8048 City/State/Zip Rancho Cordova, CA 95670 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ® MONITORING 3 ® HOLLOW STEM BORING DEPTH See Attached ❑BOLTED TRAFFIC BOX ®STOVE PIPE ❑ EXTRACTION (Vapor/Water) ❑ HAMMER/DRIVEN DIA. OF BOREHOLE 8" ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA ❑ SOILVAPOR PROBE ❑ MUD ROTARY CASING THICKNESS 2" Sch 40 PVC TYPE OF CASING: ❑ STEEL ® PVC ❑ OTHER ❑ SOIL BORING ❑ 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 PMW-01, PMW-02, and PMW-03 GROUT SPECIFICATIONS neat cement mix, 3 gallons of water per 47 Ib bag of cement DESTRUCTION WORK TO BE PERFORMED: # WELLS TO BE DESTROYED WELL IDs GROUT SPECIFICATIONS TREMIE TYPE TO BE USED ❑ AUGERS ❑ HOSE ❑ PIPE DESTRUCTION METHOD: (CHECK ALL THAT APPLY) ❑ OVER -BORE DIAMETER of inches to depth of feet ❑ ense# PRESSURE GROUT To depth of feet below surface ❑ EXPLOSIVES From to feet below surface ❑ MUSHROOM CAP ❑ 3 feet below surface or feet below surface if >3 feet See list of attached wells and well information. All IDW will be hauled off by a hazardous waste certified company. I hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. Signed Title/Company Staff Scientist at Geosyntec Consultants Print Name Jennifer Martin Date July 15, 2022 Application Accepted By: Grout Inspection By/Date Destruction Inspection By/Dates: Facility/Site Information to Issued: s FA Name p cv FA PE *102 4WP Reviewed By �� Work Plan Date � � � � C( r Z,D 2, ElC-57 X57 Authorization for Other to Sign Permit El Workers Comp El Workers Comp Waiver ElEncroachment Permit ElAccess Agreement Lead Agency Approval MFR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit g® �'� $1 x3 �'�� IIS1 00tr p� q Z soy & sZ 60B5�.� g 1868 E. Hazelton Avenue � Stockton, California 9 05 � T 209 468-3420 � F 209 464-0138 1 vvww.sjgov.org/ehd EHD 29-01 06-28-21 Site Mitigation Well Permit Application