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° v"`-� 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 800 West Church Street City/State/Zip Stockton, CA, 95203 Phone NA Cross Street N/A APN 14523004 Property Owner* Newark Group, Inc Phone (614)226-4530 Address 3200 Highlands Parkway, Suite 300 City/State/Zip Smyrna, GA 30082 C-57 Contractor Gregg Drilling, LLC License# 1044456 Phone (925)313-5800 Address 950 Howe Road City/State/Zip Martinez, CA 94553 Consultant/Sub-Contractor AECOM License# NA Phone (916)207-3053 Address 2020 L St, Suite 400 City/State/Zip Sacramento, CA 95811 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/VVells 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(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: ❑ INJECTION(Air sparge.Ozone l ❑ 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) WELV SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED 11 MOVER-BORE DIAMETER of 8 inches to depth of 25.5-80 feet WELL IDs See Table 1 of Work Plan Neat Cement ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Portland Cement-Type 1/113-556 ❑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: See Table 2 of work plan for total depths of wells to be destroyed 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. SignedL Title/Company Operations Manager/Gregg Drilling,LLC Print Na a Jake Wilson Date 9/9/2021 DEPARTMENT USE ONLY Application Accepted By: JE FREY WONG Date Issued: 9/16/2021 Grout Inspection By/Dates: Destruction Inspection By/Dates: Facilit /Site Information FA Name CTREIF STOCKTON FA Address FA# F4001 663S PR# FA PE 2960 WP Reviewed By J`7`I Work Plan Date 7/21/2021 IZ1 C-57 ❑C-57 Authorization for Other to Sign Perk ❑Workers Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ®Lead Agency Approval W MFR COMMENTS/CONDITIONS:please be aware this permit covers 5 hours of inspection including travel time. Any time incurred above the 5 hours will be billed to the billable party WP TYPE PE Sc FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2902 1 313 $152 x 5 760 cc JW 9/14/2021 WP0042547 Confirmation number 131453467 SR0084220 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd EHD 2MI 0e-28-21 Site Mitigation Well Permit Application