WP2501170 - Laserfiche WebLink

Home Browse Search

SAN - J O A Q U I N Environmental Health Department 14 1 ` _<J COUNTY � l 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 _ I 110 East Turner Road City/State/Zip Lodi, CA 95240 Phone Not Applicable Cross Street Stockton Street APN 041-24-050 a 'See attached Figure 1. Property Owner* Lustre-Cal LLC c/o Joe Hohenrider Phone (925) 876-6263 Address 13481 Forest Park Circle City/State/zip Penn Valley, CA 95946 C-57 Contractor Penecore DrillingLicense# 906899 Phone (530) 661-3600 Address 220 North East Street City/State/Zip Woodland, CA 95766 Consultant/Sub-Contractor Stephen G. Muir Consulting Geologist License# CEG #1224 Phone (209) 601-6694 Address PO Box 152 City/State/Zip Woodbridge CA 95258 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 15 feet BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ® HAMMER/DRIVEN DIA.OF BOREHOLE 3 inches ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA SOIL VAPOR PROBE 12 ❑ MUD ROTARY CASING THICKNESS NA TYPE OF CASING: ❑STEEL ❑ PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yes M No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Saarge,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH 13 and 5.5 feet TREMIE TYPE TO BE USED: ❑AUGERS ❑ HOSE ® PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes CC No (Note:Maximum Freefall Depth is 30 Ft) WELL/ BORING IDs LC 1-12 GROUT SPECIFICATIONS Hydrated bentonite at two depth zones for temporary installation Please see attached Figure 2 for proposed soil vapor probe locations and Figure 3 dual zone soil gas well completion diagram. DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑ OVER-BORE DIAMETER of inches to depth of feet WELL IDs ❑ PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑ EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑ AUGERS ❑ HOSE ❑ PIPE ❑ MUSHROOM CAP ❑ 3 feet below surface or feet below surface if>3 feet COMM EINTS-Please see attached letter from RWQCB approving Workplan.Attached Figure 5 shows proposed completion of dual zone soil gas wells.The soil gas wells will be completed as semi-permanent with surface traffic boxes. Grout to be used will be hydrated bentonite.We propose to drill and install 14.5 foot deep soil gas probe tip in each well followed by placement of hydrated bentonite fc r the deep zone followed by installation of 7.0 foot soil gas probe tip. Upper zone will not have hydrated bentonite grout installed until SJCEHD inspector is present. Surface completion will include installation of steel traffic box. All soil gas wells will be overdrilled after soil gas investigation is completed under separate permit with SJCEHD. 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 0 /c/� ,CAS_ Title/Company e/ r� AAv l_-'__6 N SUGTI/V 6- �Cp� Print Name v Date_9�2 S/ZD 2-1— J— { DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facilit /Site Information FA Name L.-lL-7 r FA Address FA# PR# FA PE c y , WP Reviewed By Work Plan Date -1 .R I �� ❑ C-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑ Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑ MFR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERR�MIT# INVOICE# Permit )et C, `j ';l $179 x 7jV3D t 1r✓ �> > 5l'J1176) 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 07-01-2025 Site Mitigation Well Permit Application