AP2400573 (2) - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN Environmental Health Department 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 Stewart Rd City/State/Zip Lathrop, CA Phone (650) 292-9062 Cross Street Somerston Pkwy APN 210-040-02 Property Owner* Califia LLC - Susan Dellosso; Contact Ryan Alameda for access Ralameda@cambaygroup.com Phone (209) 879-7900 Address N,otXTIown teW Zr- City/State/Zip Not Kn&/n Ga-4!3 'pCp.P 33 C-57 Contractor Confluence Technical Services, Inc. License# 1035255 Phone 707-639-7709 Address 6821 8th Street City/State/Zip Rio Linda, CA 95673 Consultant/Sub-Contractor EKI Environment & Water License# N/A Phone (650) 292-9100 Address 2001 Junipero Serra Blvd Ste 300 City/State/Zip Daly City, CA 94014 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 ❑ BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ 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: ElINJECTION(Air Sparse.Ozone) ElHAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ElAUGERS ❑ 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: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED 3 ❑ OVER-BORE DIAMETER of inches to depth of feet WELL IDs MWR-3, MWR-23, MWR-26 ® PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Neat Cement ❑ 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 COMMENTS: Pressure Grout Depths (MWR-): 20' (3), 22' (23), 21.7' (26) Lat, Long (MWR-): 37.7845, -121 .3314 (3); 37.77917, -121.3341 (23); 37.78461, -121.3306 (26) 1 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 Project Engineer; EKI Environment & Water, Inc. Print Name Sam Cronin Date 06/14/2024 \��DE/PARTMENT USE ONLY Application Accepted By: V Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates. Facilit /Site Information FA Name M" l�� o +✓ , �. FA Address ,,, Ulv .- FA# PR# FA PE WP Reviewed By Work Plan Date a. ❑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: C-- cif A�-VA C+l aA Y n►.� �. al•l�. b 2va�g-�c A% 7av i WP TYPE PE SC FEE INFO AMT REMITTED1 CHECK# RECV'D BY DATE WELL P;RMIT# INVOICE# Permit $y66 x t , 0(0q r 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 wwVv.sjcehd.com EHD 29-01 04-20-23 Site Mitigation Well Permit Application