Laserfiche WebLink
$ANd0AQUIN Environmental Health Department <br /> .4 ._ —COUNTY— <br /> Greatness grows here. <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> For Wells and Borings used for Contaminant Investigations and Remediation <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 48 Hours Advance Notice Required For All Inspections <br /> Application Is hereby made to San Joaquin County for a permit to construct and/or Install the work described. <br /> This application is made in compliance with San Joaquin County Development Title,Chapter 9-1115.3.and the San Joaquin County Well Standards. <br /> City/Star Zip 'RI. onICA195366 7Phone <br /> Job Address West Main Street APN 1 Z <br /> Cross Street Vera Avenue Phone 209-599209-599 <br /> Property owner' City of Ripon Ripon/CAl95366 <br /> CitylStatelZip <br /> Address 259 N Wilma Avenue License# 1049246 phone 510-357-3677 <br /> C-57 Contractor ConeTec Inc. <br /> CitylStatelZip San LeandrolCalifornial94577 <br /> Address 820 Aladdin Avenue Phone 61OA95-5105 <br /> consuLicense# <br /> Address <br /> Hale itAldrich Inc CitylStatelZip Oakland/CA/94612 <br /> Address 1956 Webster Street,Suite 300 <br /> CONSTRUCTION WORK TO BE PERFORMED:*Note: ORshe Borings/Wells Require Access Agreements or Encroachment Permits <br /> TYPE OF WELLISORING NUMBER INSTALLATION TYPE CONSTRUCTION S ❑STOVE PIPE <br /> PECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 190 feet has ❑BOLTED TRAFFIC BOX <br /> ❑ EXTRACTION(VaporMlaler) ❑ MUD ROTARY <br /> CABINDIA-O THICKN S 2 A TYPEUOFIPLE CASINGS CASI G. [I MULTI-LEVEL WELL <br /> OTHER <br /> DIA <br /> ❑ SOILVAPORPROBE ❑ MUD ROTARY CASINGTHICKNESS NIA IN Ole' Gazing Ilia: Casing Depm: <br /> ® SOIL BORING WT IHHP ® PUSH POINT(GPI CPT) CONDUCTORCASING ❑YeS ®1vo Bolin PETO BE USED: ❑AUGERS ❑HOSE ®PIPE <br /> HAND AUGER GROUT SEAL DEPTH <br /> ❑ INJECTION( ' �i o 1 ❑ OTHER GROUT SEAL PUMPED? ®Yes [INo (Note:Maximum Freetall Depth H 30 FO <br /> [I OTHER GROUT SPECIFICATIONS <br /> WELD SOIL BORING IDS +19MP-119 — <br /> 1 investigation location with up to 1 CPT and up l0 5 hydrepunch samples DESTRUCTION METHOD: (CHECK ALL THAT APPLYI <br /> DESTRUCTION WORK TO BE PERFORMED: ❑OVER-BORE DIAMETER Of�lnchestodepihof feet <br /> #WELLS TO BE DESTROYED ❑PRESSURE GROUT To depth of_feel below surface <br /> WELL IDs .❑EXPLOSIVES From Ito—feet below surface <br /> GROUT SPECIFICATIONS ❑MUSHROOM CAP ❑3I, ibelowsurfaceor feetbel urface if>3 feet <br /> TREMIE TYPE TO BE ED ❑AUGERS CHOSE ❑PIPE eS roUGd 6V/ <br /> COMMENy$�x,{ f- 'f ✓YLLt.`�iL 7 <br /> (r Y I hereby Gently am <br /> Joaquin County authorized <br /> Ordinance Cod's andStalndards, andtuatl0li and tall other ppliicab eaCalifornia laws.ance with <br /> Title/Company Protect Manaer-Hale &Aldrich, Inc <br /> Print IN <br /> Signed a /�t�� <br /> ame <br /> h enne Waldman Dale Jul 26, 2019 <br /> D ARTMENT USE ONLY � � r) F / <br /> Date Issu d: <br /> Application Accepted By: <br /> Grout Inspection BylDates: <br /> e <br /> Destruction Inspection By/Dates: <br /> l <br /> Facilit /Site Information ; FA# OJt PR# LCl-tW <br /> FA Name �- V 7� FA Address 230 V V 1 l r <br /> lD / Wok Plan Date <br /> FA PE 6 WP Reviewed By t/`-� <br /> ke <br /> El G57 G57 AuUorizagon for ONer to Sign Pemlil ❑WoAeers Comp ❑Worrs Comp Walver ❑Erxxoachmenl Permk ❑Access Agmement ❑Le Agency Approval ❑MFR <br /> COMMENT N TIONS: 1 r I I�/ , .!-I I�1.�,1,1A �� n�. D Per <br /> �fl^l U v /VyELI P MIT# INVOICE# <br /> Wp TYPE E SC FEEINFO AMT REMITTED CHECK# REC�BY DATE <br /> Permit Z 0, 3 13 $152 x 2 <br /> om <br /> 1868 E. Hazelton Avenue i Stockton, California 95205 i T 209 468-3420 i F 209 464--O8Mi8/won well Application <br /> on <br /> EHD 29-01 Oa-01-17 5 1 z)(Dy'U 7 <br />