FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

S A N 10 A Q U I N En o ro nm w�r.8A ill ',�u dh COUNTY Greatness grows here, SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours 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 Rough and Ready Island City/State/Zip Stockton, CA 95203 Phone (209) 946-0246 Cross Street W Fyffe Street APN 16203007 Property Owner* PortofStockton Phone Address 2201 Washington Street City/State/Zip Stockton, CA 95203 C-57 Contractor PeneCore Drilling License# 906899 Phone (530)661-3600 Address 220 N East St City/State/Zip Woodland, CA 95776 Consultant/Sub-Contractor Geosyntec consultants Inc License# Phone 916-637-8048 Address 3043 Gold Canal Drive, Suite#100 City/State/Zip Rancho Cordova, CA 95670 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑ BOLTED TRAFFIC BOX ❑ STOVEPIPE ❑ EXTRACTION (Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑ Yes ❑ No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION (Air Sparoe.Ozone) ❑ HANDAUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: El AUGERS I—] HOSE ❑ PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑ Yes ❑ No (Note: Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: �r/�r, DESTRUCTION METHOD: (CHECK ALL THAT APPLY) j #WELLS TO BE DESTROYED 1 ((J ® OVER-BORE DIAMETER of 6 inches to dep°(\of 17 feet WELL I�(s P-108, El PRESSURE GROUT To depth of feet below surface- GROUTSPECIFI CATIONS Neat cement grout -3galwaterto one 47mbgofpurtlandcement ❑ EXPLOSIVES From t0 feet below Surface TREMIE TYPE TO BE USED ❑ AUGERS ❑ HOSE ® (PE ❑ MUSHROOM CAP ® 3 feet below surface or feet below surface if>3 feet COMMENTS: I hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. Signed �/ Title/Company Senior Staff Scientist at Geosyntec Consultants Print Name Jennifer Martin Date January 30,2023 DEPARTMENT USE ONLY Application Accepted By: a Date Issued: 1 ZD Grout Inspection By/Dates:, Destruction Inspection By/Dates: 7 1 9 5 G 2 3 Facilit /Site Information FA Name f 0 L • \+ 64,4 1 j I FA Address t'- FA# — PR# FA PE 2 '-C WP Reviewed By /'t/� Work Plan Date ❑ C-57 -57 Authorization for Other to Sign Permit ❑ Workers Comp ❑ Worker's Comp Waiver ❑ Encroachment Permit ❑Access Agreement Lead AgencyApprov MFR COMMEfNTS/COND I�OON�S: t�0 (� �� Jt� �, ( l fL'u` vUA Yc � � -��V /4�T � ` 2� WP TYPE PE Sc FEE,INF0 AMT`REMITTED CHECK# RECV'D BY DATE WELL P(�E.RMIT#�7 INVOICE# Permit `�Q $ x i �1� �►1� ` �O ,�7 ! f-9 ?' 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 04-04-07 Site Mitigation Well Permit Application