WORK PLANS - Laserfiche WebLink

Home Browse Search

�dtilNCG SAN�JOAQUIN Environmental Health Department 7- � (( COUNTY-Greatness grows here. SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings used for Contaminant Investigations and Remediation UNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED NON-REF 48 Hours Advance Notice Required For All 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. CllylSlate2ip Vernalis CA 95385 Phone 209.835 Job Address 35100 South Hi hwa 33 .7597 APN 25-518-008 Cross Street South Well Road 'hone 303.261.2 982 Property Ovi Nutrien Ag Solutions, Inc.,Contact-Kevin Befrand CltylStatelZip Loveland Colorado 80538 Address 5296 Harvest Lake Drive License# 1058336 Phone 713.863.0 000 C-57 Contractor Cascade CltylStatelZip Woodinville,iIle Washington 98072 Address PO Box 1184 Phone 775.432.0 License# CA-PG No. 8853 247 Consultant sub-Contractor Rubik Steve Meninger-Senior GeolOaist_CltylStatelZip Reno, NV 89501 Address 320 Flint Street CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite BoringslWells Require Access Agreements or Encroachment Permits T WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS MONITORING 3 0 HOLLOW STEM BORING DEPTH fiF ®BOLTED TRAFFI X ®STOVEPIPE ❑ EXTRACTION(VaporAYaler) ❑ HAMMERCRIVEN DIA.OF BOREHOLE 8-inch ❑ MULTIPLEGASING ❑MULTI-LEVELWELL CASING DIA SOIL VAPOR Napa ❑ MUD ROTARY CA SING THICKNESS eru�n TYPE OF CASING: ❑ TEE Ca® Da:VC ❑ OTHER Casing Depth: � Bodi SOIL BORING ❑ PUSH POINT(GPI CPT) CONDUCTORCASING ❑Yes []No TREMIE TYPETOB SED: ®AUGERS ❑HOSE [I PIPE HAND AUGER GROUT SEALDEPTH ' ❑ NJECTION iN 5 ozonel ❑ GROUT SEAL PUMPED? ®Yes ❑No (Note:Maximu tall Depth 30 F D ❑ 0 ER GROUT SPECIFICATIONS WEL1p/50�1 IDs MW-'1R R MwbR nd FYNt DESTRUCTION METHOD: (CHECKALL 1067APPP� _ DESTRUCTION WORK TO BE P RFORMED: 1 If WELLS TO BE DESTROYED ❑PRESSURE GROUT To depth of feet below surface WELL ID% ❑EXPLOSIVES From to_feel below surface GROUT SPECIFICATIONS neat cement MUSHROOM CAP ❑3feet below surface or feet below surface if>3 feet TREMIE TYPE TO BE USED ❑AUGERS El HOSE 0 PIPE ❑ COMMENTS: I hereby San Joaquin County r0 dinance Codesland Standards,and all othe appl cab eion and th I th work will eCalifornia laws.done in ance with i Title/Company NutnenA Sduaons.im,lSr Man uEnNronmental RemeJiation Signed 8 Date June 3, 2020 Print Name Kevin Bertrand EP TMEN T USE ONLY Date Issued: Application Accepted By: e Zap ZO'� Grout Inspection BylDates: Destruction Inspection By/Dates: �C �/ Facilit ISite information '7 PR# V 5P q FA Address FA Name to f �A II�"l "'S $ 3 'OV /VV D Work Plan Date 6 ?j Z! id FA PE WP Reviewed By ❑G-57 G57 Authorization for Other to n Pelmll ❑WaAcees� ❑Y�i sComP FSK i�r ❑�mac men srott ❑Aoxss Ag �earnent ❑ Approval ❑MFR COMMENTSICONDITIONS: C 1 O-A ; A t V ( "` "k J IC Wp TYPE PE SC FEEINFO AMT�RLEMITr D CH ECK# REC �B DATE W00 PEROMIT# INVOICE# Permit Z9 0 1 M $152 x 3 7 1868 E. Hazelton Avenue j Stockton, California 95205 j T 209 468-3420 j F 209 464- www.sjcehd Site Miagalion WeA Pertnrt Appllce00nlion EHD29-01 0"JA7