SR2400480 - Laserfiche WebLink

Home Browse Search

Y • SA N J OAQ U I N Environmental Health Department COUNTY 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 3457 South Airport Way City/State/Zip Stockton, CA 95206 Phone Cross street South Airport Way and Perlman Drive APN I ��6s U ::?-q Property Owner* Applied Aerospace Structures Corporation Phone Address 3437 South Airport Way City/State/Zip Stockton, CA 95206 C-57 contractor EnProbe License# C-57 1012248 Phone (530)-693-0219 Address Roseville city/State/zip CA Consultant/Sub-Contractor License# Phone Address City/State/Zip CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 15 feet ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporMater) ❑ HAMMERIDRIVEN DIA.OF BOREHOLE 4 inches [IMULTIPLE CASINGS[I MULTI-LEVELWELL CASING DIA c(, ® SOILVAPORPROBE ElMUD ROTARY CASINGTHICKNESS 2.5 inches TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ❑ SOIL BORING ® PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: 1/4 inch Casing Dia: Casing Depth 5 ft,ft, 15 ft ❑ INJECTION(Air Soarge.Ozone) ® HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE 1 El OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) �`� WELL/SOIL BORING IDs SG-1,SG-2,SG-3,SG-4,SG-5,SG-6 GROUT SPECIFICATIONS At 5 ft,and at 15 ft Probe depths) - SG-7,SG-8,SG-9 DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) -'It'z> #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet Jp / 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: 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 Project Manager/AECOM Print Name Casey Sanders(Attorney-in-Fact for Gardena Holding Inc.)Date 07/03/2024 DEPARTMENT USE ONLY Application Accepted By: '� ^'---,I- Date Issued: t Grout Inspection By/Dates: ls� Destruction Inspection By/Dates: Facilit /Site Information FA Name P _ FA Address ` /t'7 t ,' \ M FA# PR# FA PE t WP Reviewed By Work Plan Date t ti� zo Zc ❑C-57 C-57 Authorization for Other to Sign Permit ❑Workers Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access AgreemenA JA Lead Agency Approval RMFR COMMENTS/CO DITIONS: g (g �ZT� Qv►� acl I eSS * s;,\I Ld r' S0► Uctlpor �rdbe s C sv�� n� S V t __�j�� 1t /� or �'41'i K S !sn ZS I"►Mr�-? qi /',kY "t vfPl'i 1 � �,'.t •_- a(,�� l�llrl� b� C" is WP TYPE PE SC I FEE INFO AMT REMITTED1 CHECK#I RECV'D BY DATE WELL PERMMIT# INVOICE# Permit ✓ U �} $len 43 e ^C� vJ I (l z 20 I I 1868 E. Xelt6n'AV A Atockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sjcehd.com y EHD 29-01 7-01-2023 Site Mit galio(t Well Pe�rnit Applica6?n r