Laserfiche WebLink
J <br /> SAN JOAQUIN Ear°, ironamental Health Depairtme t <br /> SITE MITIGATION WELL & BORING PERMIT APPLICA IONRE(161"a <br /> For Wells and Borings Used for Contaminant Investigations and Remediat dt 10 2019 <br /> r:NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED ENVIRUNM€NTAL HEALTH t <br /> �;�: `?:�rI :<E:`Az?uv NC-t�%F: :=:,r,;:€[ SJ S":1 " ¢1"i 17Yo33F1_3:{g;ns`- DEPARTMENT <br /> ,,. <br /> Application is hereby made to San Joaquin County for a permit to construct and/or Install the work described. 14 <br /> This application Is made In compliance with San Joaquin County Developmem Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. <br /> Job Address 519 Stockton Avenue city/statelzip Ripon CA 95366 Phone <br /> Cross Street NIA APN 0 Z <br /> Property Owner- Nestle USA, Inc. Phone 440-26"425 <br /> Address 5750 Harper Road Clty/Statel7Jp Solon,OH 44139 <br /> C57 Contractor Cascade Drilling Technical Services License# 938110 Phone 916368-1169 <br /> Address 3000 Duluth Street City/State/Zip West Sacramento,CA 95691 <br /> Consultantl3ub-Contractor ECMConsuhants/HaleyBAklrich License# Phone 661-255-2798 <br /> Address 3525 Hyland Avenue City/State/Zip Costa Mesa,CA 92626 <br /> CONSTRUCTION WORK TO BE PERFORMED: *Note'. Offsite BoringaMfells Require Access Agreements or Encroachment Permits <br /> TYPEOFWELUBORING N ER INSTALLATION TYPE CONSTRUCTIONSPECIFICATIONS <br /> MONITORING ❑ HOLLOWSTEM BORING DEPTH 25.5feet bgp BOLTED TRAFFIC BOX ❑STOVE PIPE <br /> EXTRACTION NepwMale) ❑ HAMMEWRJYEN DIA OF BOREHOLE I .9 inch ❑MULTIPLE CASINGS[I MUL7IlEVEL WELL CASING DIA <br /> dg-WLVAPORPROBE MUDROTARY CASINGTHICKNESS —TYPE OF CASING [I STEEL ❑WC ❑ OTHER <br /> ❑ SOILBORING PUSH POINT(GP/CPT) CONDUCTORCASING ❑Yes []No Bourg Die: CasYM Da: CaskN Dept): <br /> ❑ INJECTION(Ars,,0,1 ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED.. [I AUGERS ❑HOSE ❑PIPE <br /> ❑ OTHER ❑ OTHER. GROUTSEAL PUMPED? ❑Yes []NO (Noce MaAnum Freetall Dept)Is 30F1) <br /> WELUSOILBORNGIDs GROUTSPECIFICATIONS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECKALL THAT APPL)r) <br /> #WELLSTO BEOESTROYED ❑OVER-BORE DIAMETER of_inches to depth of feet <br /> VIELLIDs ❑PRESSUREGROUT To depth of feet below surface <br /> GROUT SPECIFICATIONS [I EXPLOSIVES Fran_to_feet below surface <br /> TREMIE TYPE TO BE USED ❑AUGERS [I HOSE ❑PIPE ❑MUSHROOM CAP ❑3 test below surface or feet below surface B>3 reel <br /> COMMENTS: <br /> I hereby certify that 1 am authorized to complete this application and that the work will be done In accordance with <br /> .� San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. <br /> Signed A'-" TNIe/Company Program Manager, ECM Consultants <br /> Print Name Binayak Acharya Date July 3,2019 <br /> DEPARTMENT USE ONLY <br /> Application Accepted By: ]A�✓ Dale Issued: <br /> Grout Inspection By/Dates: �7 <br /> Destruction Inspection By/Dates: <br /> FaelfiludSite Information I <br /> FANaae jV' FAAddress d VV.11�. UrjC..1 FA# W�J PR# O �� <br /> FA PE 6(� VIP Re*wed By vYwA� Wok Plan Data q <br /> G57 ❑C67AuModnSanf"Ot)ab fgn Pemil Wwkek Camp ❑WorWsCo Wavy ❑E=oafimeraPermt ❑Acce3sfgremlenl Agawy PWOM / R <br /> COM NTS/CONDITIONS:N r f (, //9 �L, /— �"_ <br /> WPTYPE PE S FIEF INFO AMT REMITTED CHECKS V'D REC B!YJ-/-/C DATE I WELL PERMIT# INVOICE# <br /> Permit 77 $152x � •7 r v <br /> 1868 E. ftazalion Avenue I Stockton, :;alifornia 95205 1 T 209 468-3420 ( Ift 209 464-0138 i VvVrW.sjcehd.corr. <br /> EHD 2"1 Pee1-17 SIU Mifgaaon Well Perr it AppliCaamn <br />