FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

UIN °� SAN.JOAQUIN Environmental Health Department Ia —COUNTY— ° cr " Greatness grows here. SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings Used for Contaminant Investigations and Remediation NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 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. Job Address 2150 West Alpine Avenue city/statelzip Stockton, CA 95204 Phone 209-610-8766 Cross street Franklin Avenue APN 11110001 Property Owner' Melvin Young - Centro Mart Inc. Phone 209-610-8766 Address 6507 Pacific Avenue, #335 city/statelzip Stockton, CA 95207 C-57 contractor Environmental Control Associates, Inc. (ECA) License# 695970 Phone 916,417,6858 Address 3011 Twin Palms Drive city/state/Zip Aptos. CA 95003 consultanVSub-contractor Partner Engineering and Science, Inc. License# NA Phone 559.907.7502 Address 1544 Eureka Road, Suite 180 cityfstatelzip Roseville, CA 95661 CONSTRUCTION WORK TO BE PERFORMED: *Note: Of site BoringsNVelis Require Access Agreements or Encroachment Permits TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 15 ft ❑BOLTED TRAFFIC BOX ❑STOVEPIPE ❑ EXTRACTION(Vapor/Wated ❑ HAMMERIDRIVEN DIA.OF BOREHOLE 2 5 in ,❑CheS MULTIPLE CASINGS[I MULTILEVEL WELL CASING DIA CK SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS� TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER SOIL BORING [IPUSH POINT(GPI CPT) CONDUCTORCASING ❑Yes No Bodng Dia: Casing Dia: Casing Depth: ❑ INJECTION(Arsoaae o,mel ❑ HAND AUGER GROUTSEALDEPTH UNK TREMIETYPETO REUSED: ❑AUGERS ❑HOSE 14 PIPE [I OTHER DO OTHER:Direct Push GROUT SEAL PUMPED? Yes ❑No ,(Note,Maximur�Freefall Deplh1s30 FI WELD SOIL BORING IDs rough B5 GROUTSPECIFICATIONS rout via Count r uirements. Neat Cement via Trem'P Pipe ' y�r viell LLTH S Csaw Pat ete, �� DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK TAPLY1Jby p�re�r�jrrtc, i3f #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth feet V WELL IDS ❑PRESSURE GROUT To depth ofteel belowsurface GROUT SPECIFICATIONS El EXPLOSIVES From_to_feet below suda TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below surface or feel below surface if>3 feel alAJ COMMENTS:Temporary soil gas probe to be installed within each building at 5 feet bgs. PM(ouw I to e,y ertify that I am authorized to complete this application and that the work will be done in accordance with i an Joaquin County Ordinance Codes and Standards, and all other applicable California laws. Signed Title/Company Project Geologist-Partner Engineering and Science Inc. Pdnt Name Laure Hinch Date 5/3/2022 DEPARTMENT USE ONLY / ry Application Accepted By: Date Issued: 6 O 22 1 Grout Inspection By/Dates: o Destruction Inspection By/Dates: / �' Facilit /Site Information FA Name 0 ( tk FAAddress 2150 p FA# 00 I P PR# FA PE 2 O WP Reviewed By Work Plan Date Z /� 0C-57 C-57Aulhomebon for Otherto Sign Permit ❑WorkeesComp []Workers Comp Waiver ❑/+Enaoachment Permit ❑AmessA menl ❑Lead Agency Approval FR COMMENTS! N ITIONS: /1 i,GSS b y e'morlli Q, rM1Q/ o-\ y f>Y�Y� �u)p N 0 t- � 6l M PIQ (S/2/ZOZZ). / � br (Lsu s / s 13, -7, 2 WP TYPE I PE I SC FEE INFO AMT hEMITTED1 CHECK# I RECV'D AVY I DATE WELL PERMIT# INVOICE# Permit Z ( $152x I G j L u NIQOo �t33� 1868 E. Hazelton Avenue I Stockton, California 9522(Y I T 209 468-3 0 I F 20 464-0139 t www.sjge .Com EHD 29-01 o 147 (�:I.(rvy4 +vA t I-T} 2-L+ 8't2 /I it 9 7 s W Site Mitigation Well Permit Appliwlion