WORK PLANS - Laserfiche WebLink

Home Browse Search

S A N J O A Q U I N Environmental Health Department COUNTY SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hoofs 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 14290 E-Comstock Road City/State/Zip Linden,CA 95236 Phone (209)351-0124 Cross Street Jack Tone Road APN 091-030-130.000 Property Owner" Anderson Bamgrover Ranch Phone (209)351-0124 Address PO Box 127 GltylSlaterZlp Linden,CA 95236 C-57 Contractor Confluence Technical Services,Inc. License# 1035255 �'x I /; I r ."' Phone (916)759-3512 Address 6821 81h Street CitylStatelZip Ric Linda,CA 956T3 Consultan!JSub-Contractor Brusca Associates,Inc. License# CEG#1948 Phone (996)677 1470 Address PO Box 332 CitylStatelZip Roseville,CA 95661 CONSTRUCTION WORK TO BE PERFORMED:"Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF 1fEELLIBORING DER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS Soil Gas Probe 2"dia,,b'deep ❑ MONITORING ® HOLLOW STEM BORING DEPTH 70 feet ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporMater) ❑ HAhA OMRIVEN DIA.OF BOREHOLE _$.inches ❑MULTIPLE CASINGS❑MULTkLEVEL WELL CASING DIA ® SOIL VAPOR PROBE —F—❑ MUD ROTARY CASING THICKNESS TYPE OF CASING; ❑STEEL ❑PVC ❑ OTHER © SOIL BORING 3 ❑ PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yps ❑No Boring OIa; _ Cz6log pia:_Casing Depth ❑ INJECTION(A r some.ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER © OTHER; GROUT SEAL PUMPED? ❑Yes ❑No (Nose;Manlmum Freefall Depth is 34 Ft) WELD SOIL BORING IDs TH-8,TH-9,TH-1O,SG3 GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECKALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDs ❑PRESSURE GROUT To deplh of feet below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS 0 HOSE El PIPE ❑MUSHROOM CAP El 3 feet below surface or feel below stufece If}3 feel COMMENTS: M i 3 drilled borings and 1 soil gas probe. See Workplan and Water Board approval letter nsll4� . I hereby certify that I am authorized to complete this application and that thb work will be done in accordan San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed TitIWCompany President,Brusca Associates,Inc. Print Nam Joe 13 ,sca Date 7/10/2023 w_ UEPARTMENT USE ONLY J Application Accepted By: \j Dale Issued: Grout Inspection By/Dates: } Destruction Inspection 13y/Dates: i ! Re Information FA Narne (y �f r MVl FA Address I Jtf2.161 fA1 FA# I PR# FA PE f] 1 WP Reviewed By Work Plan Date ' ❑C-57 C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Workers Camp Waiver ❑Encroachment Permit ❑Access Agreement ad Agency Approval MFR COMMENTS!¢O MTIONS: rut WP TYPE PE I SC I F r:fNFG JAMT REMITT. EDj J CHE:CC ,J K# RECV'o g DATE � WELL PERMIT# INVOICE* Permit 7$ 7 C. 2 � l,�� f 2 " ) 6 r-l-• 1868 E. Hazel#on Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 64-o4-07 Site Mitigation Well Permit Application