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SANJOAQUIN p <br /> Environmental Health Department <br /> —COUNTY— <br /> urs's`' Greolness grows here. <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 24 Hours Advance Notice Required For All Inspections <br /> CALL (209) 953-7697 For INSPECTIONS <br /> Application Is hereby made to San Joaquin County for a permit to construct and/or install the work described. <br /> This application Is made In compliance With San Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. <br /> Job Address 3314 North Delaware Ave City/State/zip Stockton/CA/95204 Phone <br /> Cross street West Alpine Ave APN 111-11OA20 <br /> Property owner Robbins Family Limited Partnership Phone 209.639.3763 <br /> Address 3247 West March Lane#200 CNy/statelzip Stockton/CA/95219-2364 <br /> C-57 Contractor Confluence Technical License# C67: 1035255 Phone 707.639.7709 <br /> Address 6821 8th Street cityletaleizip Rio Linda/CA/95673 <br /> ConsultanUSub-contractor Luke Castle, Condor Earth License# PG No. 9945 'Phone 209.513.7634 <br /> Address 188 Frank West Circle, Suite I City/Statelzip Stockton/CA/95206 <br /> CONSTRUCTION WORK TO BE PERFORMED:*Note: O#site Borings/Wells Require Access Agreements or Encroachment Permils <br /> TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 2O-30' bsci ❑BOLTED TRAFFIC BOX ❑STOVEPIPE <br /> 0 EXTRACTION(VaPorlWatel) ❑ HAMMEWDRNEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS 0 MULTI LEVELWELL CASING CIA - <br /> ❑ SOILVAPORPROBE ❑ MUDROTARY CASING THICKNESS TYPE OF CASING: OSTEEL ❑PVC ❑ OTHER <br /> 0 SOILBORING 3 0 PUSH POINT(GPICPT) CONDUCTORCASING ❑Yes 0No BaYg DO: Ca**Dla: Carbg Depth: <br /> ❑ INJECTION(Wtowaomncl ❑ HANDAUGER GROUTSEALDEPTH 30' TREMIETYPETOBEUSEO: ❑AUGERS OHOSE ®PIPE <br /> ❑ OTHER ❑ OTHER GROUT SEAL PUMPED? 0Yes 0No (Note:Maximum Freefel Depth is 30 FQ <br /> WELU SOIL BORING IDS DPADPQ,DP-3 eRouTSPEuFr-ATIONS Neat Cement in accordance with SJC Well Standards <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:fcHECK ALL THAT APPLY) <br /> #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of_feel _ <br /> WELL IDS ❑PRESSURE GROUT To depth of_feel below surface <br /> GROUT SPECIFICATIONS [I EXPLOSIVES From_to_feel belowsurface <br /> TREMIE TYPE TO BE USED []AUGERS [I ROSE [I PIPE [I MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 fool - <br /> COMMENTS: Advance three (3) direct push borings to groundwater. <br /> Destroy borings by backfilling with neat cement grout w/ tremie pipe. <br /> I hereby certify that I am authorized to complete this application and that the work will be done In accordance with <br /> , /San^ squirt ounly Ordinance Codes and Standards,and all other applicable California laws. <br /> I <br /> S(gned Tillelcompany Professional GeologistiCondor Earth <br /> Print Name Luke Castle Date 10/28/2024 <br /> i <br /> DEPARTMENT USE ONLY <br /> Application Accepted By: L-.�----+Y \ Dale Issued: <br /> Grout Inspection By/Dates: <br /> Destruction Inspection By/Dates: Ed'�✓ / '��.7�ZY' <br /> Facllll ISIIe Information <br /> FA Name -=prvv.a l A I P IVVt�(� v.1-n FAAddress •s.(bU VU . I)tta Wi J-e—0A40 <br /> FA PE 2 y J IMP Reviewed By Work Plan Dale I t 1 5-1 ,4 <br /> OG57 W47AWariulm!"Olherb Sign Permit OWakees Comp ❑workelsCompWetvar DEmoachmenlPemlll OAmssArtreemenl ❑LeadAgemyAppmal OMFR <br /> COMMENTS/CONDITIONS: fior C-5) �Oi k G S 5t.t � <br /> CID( <br /> WP TYPE PE I SC I FEE INFO JAMT REmITTED1 CHECK#I RECV'D BY I DATi�EIl��11I WELL PERMIT# INVOICE# I <br /> Permit 2 OI,v � 3l ?J $172 x `7 i L' (r )i•7'oG-1' W�'.Z�(��3L� <br /> , ,, qq I <br /> 1868 E. Hazellon Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138/�rr ��W`w sjcehdd d.bom <br /> EHD 29M o&Ut-2024 Site MWgaaon Well Permll Appllwllon <br />