WORK PLANS - Laserfiche WebLink

Home Browse Search

SA N :J OAQ U I N Environmental Health Department —COUNTY- SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ct:rs Advarice Nudii c: 1:equir;c3 f or All Iflspeclions Cal- (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 'S Cil : ttZWk,w�L:,/ City/State/Zip Stockton,California 95206 Phone (209)468-4700 Cross Street Arch Airport Road / ApN 177-260-340 Property Owner* County of San Joaquin Phone (209)468-4700 Address 5000 S Airport Way City/State/Zip Stockton,California 95206 C-57 Contractor M R Drilling License# C-57#740854 exp.,9/30/25 Phone (714)994-0402 Address 7431 Walnut Ave City/State/Zip Buena Park,California 90620 Consultant/Sub-Contractor BSK Associates License# n/a Phone (559)497-2880 Address 9332 Tech Center Drive,Suite 100 City/State/Zip Sacramento,California 95826 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ZI MONITORING _ 3 ® HOLLOW STEM BORING DEPTH approx.60ft 01 BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) Cl HAMMER/DRIVEN DIA.OF BOREHOLE 8'1 ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS Sch 40 PVC TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: 8" Casing Dia: 2" Casing Depth: 60ft ❑ INJECTION(Air Soarge.Ozone l ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE E PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ®Yes ❑No (Note:Maximum Freefall Depth Is 30 Ft) WELL/SOIL BORING IDs MVt/-5 M W-6 &M W-7 GROUT SPECIFICATIONS Neat cement or sand/cement grout with 5%bentonite See attached workolan. DESTRUCTION WORK TO BE PERFORMED: N/A DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑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: I hereby certify that I am r4horized to complete this application and that the work will be done in accordance with an J uin w ty Ordinance Codes and Standards,and all other applicable California laws. Signed nn__j�,,M�,��,,, Title/Compan ICI .C- QP.�jsr[- f I�S� Print Name L�JGK'r N�T-c-01 V Date 3 f DEPARTMENT USE ONLY Application Accepted By:-_- - �-4_ Date Issued: Grout Inspection By/Dates: Vf f IPA (171512B25 IiA VJ ,V<'} l Destruction Inspection By/Dates: F cili / Ite Information FA Name F U L�/� V t`� FA Address —t7 O C;� c, FA# (,, PR# FA PE G WP Reviewed By Work Plan Date 3 t If,Ct;57 t�57Authodzation for Other to Sign Permit orker s Comp ❑Workers mp Waver ❑Encroachment Permit ❑Access Agreement PRead Agency Approval !!!JMFR COMMENTS/CONDITIONS: / \ l V1w L� fLv� WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT#l� INVOICE# Permit iILo 51I'� $172 x ((� 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 www.sjcehd.com EHD 29-01 08-01-2024 �L_D L)2 q' 2, 1 Site Mitigation Well Permit Application