SR2602168 - Laserfiche WebLink

Home Browse Search

,f,,Puuc: S A N J O A Q U I N Environmental Health Department ---- -COUNTY Greatness grows her . 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 26700 South Banta Road City/State/Zip Tracy,CA 95304 Phone (408)599AO30 Cross Street W Llnne Road APN 252-010-070-000 Property Owner` unionPacifiicRailroad—ScottSelken Phone (402)5444159 Address 1400 Douglas Street Stop 1030 City/State/Zip Omaha,NE 68179 C-57 Contractor Calwater Drilling License# 434218 Phone (209)667-7932 Address 300 S.Kilroy Road City/State/Zip Tudock,CA 95380 Consultant/Sub-Contractor Geosyntec consultants License# 766859 Phone (510)285-2682 Address 1111 Broadway,6th Floor City/State/Zip Oakland,CA 94607 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporlWater) ❑ HAMMERIDRIVEN 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(GPI CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Saarae,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑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 1 ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDS MW-5(see attached work Plan) ®PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Portland cement mixed with 3-5%bentonite gel ❑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: I hereby certify that I am authorized to complete this application and that the work will be done in accordance with �Sa Jo qufn County Ordinance Codes and Standards,and all other applicable California laws. Signed� Title/Company CalWater Drilling Company,Inc. Print Name Matt Hennings Date 5/15/2026 DEPARTMENT USE ONLY Application Accepted By: �-/ .L�~(�� Date Issued: Grout Inspection By/Dates: ✓/ ` Destruction Inspection By/Dates: Facility/Site Information FA Name �i �y�p j� I Lwl t FA Address FA# PR# FA PE l V WP Reviewed By i. Work Plan Date I �. C-57 ❑C-57 Authorization for Other to Sign Permit ❑Workers Comp ❑Worker's Comp Waiver ❑Encroachment Permit '®Pccess Agreement,"❑Lead Agency Approval ❑MFR COMMENTS/CONDITIONS: WP TYPE PE SC I FEE INFO AMT REMITTED CHECK#I RECV'D BY DATE ,'WELL PERMIT# INVOICE# Permit I .? $179 x I -1 y, ! ;/ . [q PLG 0 17 2'� 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHO 29-01 07-01-2025 Site Mitigation Well Permit Application