Laserfiche WebLink
SAN JOAWN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 24 Hours Advance Notice Required For All Inspections <br /> CALL (209) 953-7697 For INSPECTIONS <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 9-1115.3,and the San Joaquin County Well Standards. <br /> Job Address Dos Reis Rd. (Let: 37,83022 Long• -121 3081) City/statealp Lathrop, CA Phone (650) 292-9062 <br /> Cross Street N/A APN 192-020-18 <br /> Property Owner- City of Lathrop Phone (209) 941-7430 <br /> Address 390 Towne Centre Drive city/state/zip Lathrop, CA 95330 <br /> C-57 Contractor Confluence Technical Services, Inc. License# 1035255 Phone 707-639-7709 <br /> Address 6821 8th Street cityistate/zip Rio Linda, CA 95673 <br /> ConsultantlBub•Contractor EKI Environment&Water License# N/A Phone (650) 292-9100 <br /> Address 2001 Junipero Serra Blvd Ste 300 City/State/Zip Daly City, CA 94014 <br /> CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Bodngs/Welis Require Access Agreements or Encroachment Permits <br /> TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOWSTEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE <br /> ❑ EXTRACTION(Vap fflalei) ❑ HAMMERNRNEN DA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA <br /> ❑ SOILVAPORPROBE ❑ MUDROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER <br /> ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTORCASING ❑Yes ❑No Writ Die: Casing Dla: Caft Depth: <br /> ❑ INJECTION(w,3oarw w,) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE <br /> ❑ OTHER ❑ OTHER: GROUTSEAL PUMPED? ❑Yes ❑NO (Noe:Maximum Freefal Depth Is30 FQ <br /> WELU SOIL BORING IDS GROUTSPECIFICATIONS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br /> #WELLS TO BE DESTROYED 1 [I OVER-BORE DIAMETER of_inches to depth of feet <br /> WELLIDS CLSP-8 OPRESSUREGROUT Todepthof 16.5 feetbelowsudaw <br /> GROUT SPECIFICATIONS Neat Cement ❑EXPLOSIVES From_to—feet below surface <br /> TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ®PIPE OMUSHROOMCAP 03 feet below sudaw or feet below surface if>3 feet <br /> COMMENTS: <br /> The mushroom cap will be excavated 20 inches wide and 3 feet below surface. <br /> 1 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 Title/company Project Engineer; EKI Environment & Water, Inc. <br /> Print Name Emmanuel Fonseca Date 26 October 2023 <br /> DEPARTMENT USE ONLY <br /> Application Accepted By: I r-,/A Date Issued: <br /> Grout Inspection By/Dates: <br /> Destruction Inspection By/Dates: <br /> Faclli /Site Information <br /> FA Name 2 FA Address - ✓ t, _ FA# �� '.7� C�� "Z PR# 0 go <br /> FA PE 2.Cl 6 ,5 WP Reviewed By Work Plan Date C U - - <br /> ❑C57 VjP57AW1WdMUDnWOtherIoSIiInPemIt ❑Wakens Camp ❑Wakens Comp Waver VEncromlimentPernt ❑Access Agreement 0 Lead AgericyAWaval R.MFR <br /> COMMENTS/CONDITIONS: - <br /> IMP TYPE PE I <br /> ?1SC FEE INFO AMT REMITTED CHECK# RECV-D IBY -DATE WELL PERMIT# INVOICE# <br /> Permit Z90 -3127 $ I � 6 CC ( V Il 9 7l d 6j0Jj l <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 Iswy jceh9.0com <br /> END 29-01 oa-2a23 I 1 I -fTo 106 n see Miligali Well PemmApplicaeon <br />