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S A N . J O A Q U I N Environmental Health Department COU NTY 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 26700 South Banta Rd. City/State/Zip Tracy/CA/95304 Phone NA Cross Street W.Linne Rd. APN 25201007 Property Owner* Olin Corporation Phone (408)599-4030 Address 3855 North Ocoee St.,Suite 1100 City/State/Zip Cleveland/TN/37312 C-57 Contractor Cascade License# 1058336 Phone (510)478-0858 Address 120 S.23rd St. City/State/Zip Richmond/CA/94804 Consultant/Sub-Contractor Wood. License# PG 10032 Phone (510)637-8057 Address 555 12th Street,Suite 215 City/State/Zip Oakland/CA/94607 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 1 ® HOLLOW STEM BORING DEPTH 50 feet bgs ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 8 inches ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS ASTM Schad 80 TYPE OF CASING: ❑STEEL ®PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: 8 inches Casing Dia: 2 inches Casing Depth: 0-48 feet bgs ❑ INJECTION(Air Soame,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH 3-40 feet bgs 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 MW-17.See attached Work Plan for location. GROUT SPECIFICATIONS Neat cement(94 lb bag/5-10 gal water) DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED' ®OVER-BORE DIAMETER of_0_inches to depth of 3 feet WELL IDs MW-6.See attached Work Plan for Locations. ®PRESSURE GROUT To depth of 3-20 feet below surface GROUT SPECIFICATIONS Neat cement(94lb bag/5-6 gal water) ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS [IHOSE ®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 San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed Q�r,/ae,4- Title/Company Wood. Print Name Ja son Reeder Date 8/3/22 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facilit /Site Information FA Name FA Address FA# PR# FA PE WP Reviewed By Work Plan Date ❑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: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit $152 x 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 04-04-07 Site Mitigation Well Permit Application