FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

S A N J O A Q U I N Environmental Health Department -J i'1_: ,. i -- COUNTY- -1 �_, r. � Greatness groris 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 16777 Howland Road City/State/Zip Lathrop, CA 95330 Phone 209-858-2511 Cross Street E Louise Avenue APN 19818001 Property Owner' Property: J.R. Simplot; Well Owner: Glenn Springs Holdings Phone Address 16777 Howland Road City/State/Zip Lathrop, CA 95330 C-57 Contractor Gregg Drilling, LLC License# 1044456 Phone 562-427-6899 Address 2726 Walnut Avenue City/Statelzip Signal Hill, CA 90755 Consultant/Sub-Contractor Arcad'Is US Inc License# 571846 Phone 209-663-8884 Address 400 Capitol Mall, Suite 900 City/State/Zip Sacramento, CA 95814 CONSTRUCTION WORK TO BE PERFORMED: 'Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS I0 MONITORING �— X HOLLOW STEM BORING DEPTH 25 feet I2 BOLTED TRAFFIC BOX ❑ STOVE PIPE ❑ EXTRACTION(VaporlWaler) Li HAMMERIDRIVEN DIA.OF BOREHOLE 8 inches ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS 0.154 inches TYPE OF CASING: ❑ STEEL I;3 PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes l3 No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Soarce.Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE I0 PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑ Yes I,a No (Nate:Maximum Freefall Depth is 30 Ft) WELL/ BORING IDs to/_ ) R GROUT SPECIFICATIONS Type I�aat cement runt tt 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 COMMENTS: 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 ' r 'w"— `� Arcadis US Inc Title/Company Print Name Christine Hughes Date 10/17/2024 DEPARTMENT USE ONLY Application Accepted By: � Date Issued: 1 121 2,1 `2� Grout Inspection By/Dates: Destruction Inspection By/Dates: Facilit /Site Information FA Name !—o�wa�1r Ui�,�6.- FA Address �'�- t�oc�p w� yt FA# ( �Z PR# (� 5 U FA PE 2.0 WP Reviewed By - _ Work Plan Date t, U ❑ C-57 C-57 Authorzat on for Other to Sign Permit ❑ Workers Comp ❑Wok is omp Waiver ❑ Encroachment Permit ❑ Access Agreement lead Agency Approval MFR COMMENTS/CONDITIONS: e;a?141i rl.tpu� � i't-t C r J>< J WP TYPE PE SC FEE INFO AMT REMITTED CHECK# REC 'D Y DATE WELL PERMIT#\ INVOICE# Permit 2 1 j( 3 $172 x M; kA�uJ ' ) (V ..t110 1 , G 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehdi.com �(t24\ oofg1 EHD 29-01 08-01-2024 Site Mitigation Well Permit Application