WORK PLANS - Laserfiche WebLink

Home Browse Search

SAN.�JOAQUIN Environmental Health Department —COUNTY— `=ii, ,,,,0 Greatness 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 1024 E. Market St. City/StatelZip Stockton, CA 95205 Phone N/A Cross Street S Union St APN 15124002 Property Owner* Sepulveda, Julian Jr. and Mary Jane Phone N/A Address City/State/Zip C-57 Contractor Cascade Drilling Chris Tatum License# 1058336 Phone 510-772-0841 Address 3459 Collins Ave City/State/Zip Richmond, CA 94806 ConsultanUSub-Contractor License# Phone Address City/State/Zip CONSTRUCTION WORK TO BE PERFORMED: 'Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 11 feet ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporMaler) ® HAMMERDRIVEN DIA.OF BOREHOLE 2251nches ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOILVAPORPROBE ❑ MUD ROTARY CASING THICKNESS TYPEOF CASING: ❑STEEL ❑PVC ❑ OTHER ® SOILBORING 2 ❑ PUSH POINT(GPI CPT) CONWCTORCASING ❑Yes ❑No Boling Dia: Casing Dla: Casing Depth: ❑ INJECTION(At soaae.0zana) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPETO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ®No (Note:Maximum Fmefall Depth is 30 F1 s �• WELUSOIL BORING IDS 2-8150,2-132S0 GROUT SPECIFICATIONS neat-men ,L DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLYI It WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of feel WELL IDS ❑PRESSUREGROUT To depth of feel below sudace r GROUT SPECIFICATIONS [I EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below surface or feel below surface if>3 feet COMMENTS: OPT drilling of two 11-feet deep soil borings for environmental soil sampling. Analysis to include TPH-GRO, TPH-DRO/RRO, and CAM-17 metals. I hereby certify that I am authorized to complete this application and that the work will be done in accordance with osquirt County Ordinance Codes and Standards,and all other applicable California laws. Signed—�/ �g� Z _ Title/Company BU Manager - Cascade Print Name Chris Tatum Date 7/6/2023 DEPARTMENT USE ONLY / Application Accepted By: Date Issued: x 0 / 2 iqu Grout Inspection By/Dales: Yb Destruction Inspection BylDates: Facilit /Site Information FA Name J R FAAddress OLAQX FA# 4 Z PR# 00GT FA PE 2 5 6 WP Reviewed By WorkPlanDate 1„lLAG57 ❑G57Aullariza6on Ober 'gr:Pe t ❑Workers Gomp ❑Workers Comp Waiver ❑Encroachment Permit ss Agreement ❑Lead Agency AR COM S/CONDITIONS: ( 0 t pl,cots,,g L'1�:iV1, waIrvO kesf K o D C > �- WP TYPE PE I SC I , /1 !FEE INFO AMT REMITTED CHECCK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 290 .313 slpx � 3 24' r, I 5W ��0 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 968-3420 1 F 209 464-0138 1 vJWw.s��P .co 5 EHD 29-0104-20-23 C C I &S—o g?. b el 2 Site Mitigation Well Pennit Application