Laserfiche WebLink
A 9AQ� � �r12r�i� i81$oe1th Dep�ft"10nt <br /> RECEIVED <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATIONUL 1 <br /> 0 2019 <br /> For Wells and Borings Used for Contaminant Investigations and RemegWUMANMENTAL HEALTH DEPARTMENT <br /> NON- EFU LE PE IT EXPIRES 1 EAR FROM DATE I9SSUED <br /> -R e. <•;s S)i?!,`=: 'tt iC{; f{.�:itEs?' •^,� 'E3 ' i• tl �:.:xt-D i.lnf< <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 Rrpon CA 1113,and <br /> the <br /> San Joaquin PC phone <br /> Well Stan__ <br /> Job Address On Ciry Parking lot west of Industrial Avenue APNStateRip <br /> 9-599-21108 <br /> NIA Phone (20 <br /> Cross Street City of Ripon <br /> Property OwneP Cltylstatelzip Ripon.CA 95366 91&368-1169 <br /> 259 IN Wilma Avenue 938110 phone �-- <br /> Address License# <br /> Cascade Drilling Technical Services Vilest Sacramento,CA 95691 <br /> C-67 Contractor CltylstatelZlp 661-255-2798 <br /> 30D0 Duluth Street Phone �-- <br /> Address ECM ConsullantslHaley&Aldrich License# <br /> ConsultarNsub-Contractor Mylatatelzip Costa Mesa CA 92626 <br /> Address 3526 Hyland Avenue <br /> CONSTRUCTION WORK TO BE PERFORMED:*Note: Offs(le BoringsANells Requite Access Agreements or Encroachment Permits <br /> rrinN SPECIFICATIONS <br /> TYPE OFWEL BORING N_UPER INSTALLATION-TYPE _ y45feetbgs ❑BOLTED TRAFFIC BOX ❑STGVEPIPE <br /> ❑ HOLLOWSTFAI BORING DEPTH — ❑MULTIPLE CASINGS❑MULTIIEVELWELLCASINGDIA� <br /> q:ITORiNG ❑ HAMMERIORNEN DIAOF6ORFHOLE -�210Ci` — OF CASING: 0 STEEL 0PJC O OTHER <br /> ❑ FxTRACTION{VzporAVate6 MIA ROTARY CASINGTHICNNESS�� Cadre Ga: Ca4ng DepN: <br /> CC��SGLVAPORPROSE MUD <br /> OTARPOINT(GP/CPT) CONDUCTORCASING ❑y� 13140 IETYPETO BEUSEU G AUGERS p HOSE O PIPE <br /> �"CiOL BORING � HAND AUGFR GROUT SEAL DEPTH <br /> Terrill <br /> TREM <br /> ❑ INJECTIOTHER <br /> _° x OTHER: <br /> GROUT SEAL PUMPED? ❑Yes ❑No (NoMadmum Fleefall DaPthb30 R) <br /> ❑ OTHER GROUT SPEGFICApONS <br /> WELUSGLBORINGIDs <br /> DESTR CTION METHOD• (CHECI<ALLTHATAPPLY7 <br /> ❑OVER-BORE DIAMETER oI_inches to depth of_�leet <br /> DESLSTOBEONWORKTOBEPERFORMED: ❑PRESSUREGROUT To depth of—feet andace <br /> #WELLS TO BE DESTROYED to feelbeloWsudaw <br /> te <br /> WELLIDS ❑EXPLOSIVES From seat below sudace 9>3 feet <br /> GROUT SPECIFICATIONS MUSHROOM CAP ❑3feetbdav surface <br /> TREMIETYPETOBEUSED []AUGERS []HOSE ❑PIPE <br /> COMMENTS: <br /> 1 hereby cerily rapplicat <br /> that l am authorized to complete th s applicallon and/fiat the workwill be done Sn accortlanee With <br /> San Joaquin County ordinance Codes and standards,relCompan)f IlProgram Mana other ger.FCM Consue California ltants <br /> Signed I-L-- Date July 3,2019 <br /> Binayak Acharya <br /> Print Name <br /> EPARTME <br /> oth <br /> -- Date Issued: <br /> Application Accepted By: <br /> Grout Inspection By/Dates: - <br /> Destruction Inspection By/08tes: C P 67 <br /> Facilit IS 011 to a o FA# VU JJ D <br /> FA Address 6 <br /> FAName •Q— � Work Plan Dale <br /> VIP Reviewed BY /waoval�MFR <br /> FA PE adlmenT Pemiil ❑AooessAgreemml <br /> 7 ❑C57AxAhairaIIAfaOdx`Io Sign FUCA Wod:ees Carp ❑WoNars Cane aim <br /> COM ENTSICONDITIONtS:/ C ryv , h4 ' `^"'S <br /> Wp TYPE PE sc FEE INFO AMT REh RECV'D BY DATE WEL MIT#_ INVOICE# <br /> Permit ' 152x Vrb/AVW..Scehd.00M <br /> aiifornia 95205 ! T 209 468-342 1 209 464-0138 I nwes PamIlAPOoarkn <br /> 1868 E. Nazelton Avenue I Stockton, .. <br /> sne uisBalm <br /> EH02"I n84ir-17 <br />