WP0042894 - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN Environmental Health Department ; = COUNTY Greatness OUNTYGreatness grows here . 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 122 N . Wilson Way City/State/Zip Stockton , CA 95205 Phone 209462 -5659 Cross Street N . Wilson Way & Channel ST . APN 153 - 040 -210 - 000 Property Owner* San Joaquin Marketing Association Phone 209462 -5659 Address 122 N . Wilson Way City/State/Zip Stockton , CA 95205 C -57 Contractor Encon Technologies , Inc . License# 748576 A- HAZ , C57 Phone 562 -777 -2200 Address 12145 Mora Dr . Suite 7 City/State/Zip Santa Fe Springs , CA 90670 Consultant/Sub - Contractor Encon Technologies , Inc . License# 748576 A - HAZ , C57 Phone 562 -777 -2200 Address 12145 Mora Dr . Suite 7 city/State/Zip Santa Fe Springs - CA 90670 CONSTRUCTION WORK TO BE PERFORMED : * Note : Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑ BOLTED TRAFFIC BOX ❑ STOVE PIPE ❑ EXTRACTION (Vapor/Water) ❑ HAMMER/DRIVEN DIA, OF BOREHOLE ❑ MULTIPLE CASINGS ❑ MULTI -LEVEL WELL CASING DIA ® SOIL VAPOR PROBE 3 ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING : ❑ STEEL ❑ PVC ❑ OTHER ® SOIL BORING 11 ❑ 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) � WELLI SOIL BORING IDs sB1 . sB2. SB3 , SB4, SB5 , SB6, SB9 , SB1o , SB11 GROUT SPECIFICATIONS Ll SB12, SV1 , SV2 , SV3 DESTRUCTION WORK TO BE PERFORMED : DESTRUCTION METHOD : (CHECK ALL. THAT APPLY) # WELLS TO BE DESTROYED NIA ❑ 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 : e by certif at I m authorized to complete this application and that the work will be done in accordance with a Jo q n t Ordin nce Codes and Standards , and all other applicable California laws . Signed Title/Company President , Encon Technologies , Inc . Print Name J se h Scatoloni Date 12/29/2021 DEPARTMENT USE ONLY Application Accepted By : Date Issued : /Z) Z2 Grout Inspection By/Dates : 2np I Ave I Destruction Inspection By/ Dates : Facilit /Site Information FA Name � FA Address Z FA# l) Q 2, PR# FA PE 2mAWP Reviewed By I Work Plan Date Z l Z9 Z C- 57 ❑ C- 57 Authorization for Other to Sign Permit ❑ Worker's Comp ❑ Worker's Comp Waiver ❑ Encroachment Permit rAccess Agreement ❑ Lead Agency Approval YUMFIR COMMENTS/CONDITIONS : � µ b � pO �- � ( ® �/e �C,,� `�'` ft" S 13. 2- WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV '`D/ B�Y DATE WELL PERMIT# INVOICE# Permit 3 I $ 152x _ 456 aC� A/ZZ vv V W W JA #%% 576Z4 ::? Zz4oO Svw� 0(� 4 1 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 1 F 209 464 - 013$ www . sjgov . org /ehd EHD 29-01 06-28-21 Site Mitigation Well Permit Application