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SAN JOANN 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 9-1116.3,and the San Joaquin County Well Standards. Job Address 16888 McKinley Avenue Citylstate/Zip Lathrop, CA 95330 Phone (209)858-2010 Cross Street Lague Road APN 198-160-26 Property owner* Super Store Industries Atln: Tom Hughes Phone (209)858-2010 Address 16888 McKinley Avenue city/State/Zip Lathrop, CA 95330 C57 Contractor. Gregg Drilling,LLC License# 1044456 W of j e ;LwPhone 925-313-5800 Address 2100 Goodyear Rd. City/State/Zip Benicia,CA 94510 Consultant/Sub-Contractor ARCADIS US INC Attn: Miljan DraganiC License# Phone (510) 590-2540 Address 400 Capitol Mail, 9th Floor City/State/Zip Sacramento, CA 95814 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Bodngs/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 15 feet max ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VapalWater) ❑ HAMMERIDRNEN DIA OF BOREHOLE 4Inches ❑MULTIPLE CASINGS MULTI-LEVELWELL CASING DIA ® SOILVAPORPROBE 3 ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ® SOLBORING 15 ® PUSH POINT(GPI CPT) CONDUCTORCASING ❑Yes ❑No Baling Dia: Gasing Dia: Casing Depth: ❑ INJECTION IPasmme.ozanel _ IZ HAND AUGER GROUT SEAL DEPTH TREMIETYPETO BE USED: ❑AUGERS ❑HOSE RIPIPE [IOTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Ma)dmum Freefall Depth Is 30 FI) WELL/SOIL BORING IDS SV-6 through SV-8 GROUT SPECIFICATIONS After sample collection a ch borehole will be backfilled with rout to 1 SB-1 through SB-15 match existing grade. 0- ,. .tA DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECKALIrfAAr PPLLY) yn Akry-_ �5 fl�4,tCea #WELLS TO BE DESTROYED n/a ❑OVERBORE DIAMETER of—Inches to depth of—feet Su� 0.5 WELL We ❑ PRESSURE GROUT To depth of feel below surface bb� D IIQY-c{h� I I j I'I.y GROUT SPECIFICATIONS El EXPLOSIVES From—to—feel belay sudace v TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ❑PIPE ❑ MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: This work is part of a Phase II site investigation where a total of 17 borings will be advanced using hand augers and direct push technology to collect soil, groundwater, and soil vapor grab samples (one soil boring will be converted into a vapor probe location . This is work Is not directed by the DTSC or the RWQCB. Please contact ARCADIS with any questions. Figure attached. I hereby certify that I am authorized to complete this application and that the work will be done in accordance with n // San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed 41— Title/Company Project Manager, Gregg Drilling, LLC Print Name Ryan Lea Date 2120/2024 EP RTMENT USE ONLY Application Accepted By: Dale Issued: t L 12 Grout Inspection By/Dates: Destruction Inspection By/Dates: Faclll /Slte Information FA theme 5umr rR {Q FAAddress I Tq $8 MjfjVk I FA# Q d PR# p S I Q 5q FA PE Z Q WP Reviewed By 'AjWolk Plan Date 7 ❑C57AWWzattwfa OthertuSign Permit ❑WwWs" ❑WaWsComp Waver ❑Encroachment Pemu ❑Access reemeni ❑LeadAgency4proval FR COMMENTS/CONDI]T'IONS: LrJ; Ira.` O✓J'S $ q, 9 D IS ( — M iR_m rA4�,a js a be v f� ac(A ikf rW r�jS;n� ; F G s 4" th 6 e ck`%N ¢� IA. wo uMCe Xe D o 1"Ctl 0.k 4 .ter 4c WP TYPE I PE I SC FEE INFO AMT REMITTED CHEC�IK# RECV'D BY DATE WELL P�ERMIT# INVOICE# 3 Permit $162x Cc 8 Zv- W oo�lf. 33 209 - sRoo �o 1868 E. Hazelton Avenue I Stockton, California 95205 � T 20 46 420 I F 209 464-0138 1 www.sjcefid.com EHD 29-M 7-01-2023 She Mitigation Well Permit Application