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SAN JOAQUIN Environmental Health Department Ll r —COUNTY— "j14 FGnP� — ` 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 4900 E Mariposa Road CltylState/Zip Stockton/CA/95215 Phone - 4�r� 2 Cross Street Carpenter Road APN 179-160-210 A' Property Owner` Donald and Nita Rienhart Phone 403-922-9223 Address 3060 Canal Dr City/State/Zip Stockton/CA/95204 C-57 Contractor Confluence Technical Services, Inc. License# 1035255 Phone 707-639-7709 Address 6821 8th Street City/State/ZIP Rio Linda/CA/95673 Consultant/Sub-Contractor Luke Castle,Condor Earth License# PG No. 9945 Phone 209-513-7634 Address 188 Frank West Circle, Suite I City/State/Zip Stockton/CA/95206 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ee a ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) LI HAMMER/DRIVEN DIA.OF BOREHOLE S ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOILVAPORPROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER 17 SOILBORING 5 17 PUSH POINT(GP/CPT) CONDUCTORCASING ❑Yes [I No Baring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Airsoxae.oxmel ❑ HANDAUGER GROUT SEALDEPTH MI /' S ❑HOSE ®PIPE El OTHER ❑ OTHER: GROUT SEAL PUMPED? El Yes El No (Note:Maximum Freefall Depth ls30 FA WLEWSOIILBORING IDS Bl through B5 GROUT SPECIFICATIONS Neal Ce u Oill 6� 'jf 11 a uCTION � cs, dots• • £ND rtWrAP cRrrcft qr,w t dapF�T DESTRUCTION WORK TO BE E FORMED: �r DESTRUCTION ME OD: TCHECKALLYHATAPPLYI #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet 1 WELL IDs ❑PRESSURE GROUT To depth of feel below surface GROUT SPECIFICATIONS El EXPLOSIVES From—to—feet below surface TREMIE TYPE TO BE USED El AUGERS [I HOSE [I PIPE El MUSHROOM CAP ❑3 feel below surface or feet balm surface if>3 feel COMMENTS: 1 through DP-9 borings are up to 10-25 feet bgs. b p�� sl-0.,�5 (/ D to J� 1, ��pmM.Q rS ry if i0o"W5 AR's wo--6tr OT'- :F i �l's dd2r1 d /A 7 I hereby certify that I am authorized to complete this application and that the work will be done in acdordancrWith / /$Jan Joaquin County Ordinance Codes and Standards, and all other applicable California laws. j Signed !.Ll� (�!L6U.� Title/Company Geologist.Censor Earth PG No.W45 Print Name Luke Castle Date 12/1212023 DEPARTMENT USE ONLY n / Application Accepted By: Date Issued: 2 2 ( ( Z Grout Inspection By/Dales: Destruction Inspection By/Dates: Facilit /Site Information FAName Woo a-i At kwofl FAAddress 4 oo 67. otr D FA# Iroo—*46 6 1 PR# In oOR-1 FA PE 19 ,OU WP Reviewed By / Work Plan Date11 -2, 117-IZ023 0G-57 G57 AuU*dzaVm for Otherto Sign Permit ❑Workers Comp ❑Workers Camp Waiver ❑Encroachment Permit VAccessAgmement ❑Lead Agency Approval FR COMMENTSI ONDITIONS: Subm.l L �� ,P � s •rp D �/�I,� S Y&Q- eLprf�;u(�b� WP TYPE I PE Sc FEE INFO AMT REMiTTED1 CHECK# I RECV-D BY I DATE 1,rWELL P(E�RM`IT#�-y� IC INVOE# ' Permit ZRo tj 31 3 S x 1+9 GC T� L Z o i Vy 0D -` J 1 J(/ rC A 3 6 'Il-,S� Z 9 S/Z en%i"5s5 1868 E. Hazelton Avenue I Stockton,-California 95205 I T 209 8-3420 1 F 209 464-0138 1 www.sjgov.org/ehd EHD 29-01 OB-2e-21 Site Mitigation Well Pemit Applice lon