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S A N ) U A Q U I N Environmental Health Department COUNTY-- Crenttic", g1m,"s /Io$c. AYIWEN " SITE MITIGATION WELL & BORING PERMIT APPLICATION R"CIFI ,E® NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED JI'lN 11 2026 24 Hours Advance Notice Required For All Inspections 8ANJ0AQjjA1 Q CALL (209) 953-7697 For INSPECTIONS �IdVlf�(nw,-P��UP�T1' Application is hereby made to San Joaquin County for a permit to construct and/or install the work described:'QL7!•! Al This application is made in compliance with San Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Suw&L 4-r Job address 1443 Navy Drive City/State/Zip Stockton, CA 95206 Phone Cross Street South Pershing Avenue APN 163-300-230-000 Property Owner* Mr. Abbas Mash Phone 925-487-8075 Address 18 Deer Oaks Drive City/State/Zip Pleasanton, CA 94588 C-57 Contractor Environmental Control Associates (ECA) License# 695970 Phone 530-441-8393 Address 3011 Twin Palms Drive City/State/zip Aptos, CA 95003 Consultant/Sub-Contractor Benchmark Environmental, Inc. License# N/A Phone 925-998-3905 Address 3338 Hadsell Court city/State/Zip Pleasanton, CA 94588 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 20 feet ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 2.25 Inches ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING CIA [I SOIL VAPOR PROBE C1 MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL [I PVC ❑ OTHER Ll� SOIL BORING pQ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes []No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Soarge.Ozone) ❑ HAND AUGER GROUT SEAL DEPTH 20 feet TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELU SOIL BORING IDs GROUT SPECIFICATIONS Neat Cement In accordance w/San Joaquin County well standards DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THATAPPLYI #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDS ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑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: 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 �Qt 6IM4—• Title/Company CEO/Benchmark Environmental, Inc. Print Name Ramin Bet-Yonan Date June 10, 2026 DEPARTMENT USE ONLY Application Accepted By: A--YA Date Issued: t t I 1 L Grout Inspection By/Dates: �j�� ;?-Z6I26 Destruction Inspection By/Dates: Facilit /Site Information FA Name I V ; y I �v�� ( FA Address I ,JA 1k3 V')O_U Y FA# PR# FA PE -b WP Reviewed By Work Plan Date (3 u1 I ❑C-57 -57 Authorization for Other to Sign Permit '90vorker's Comp ❑Workers Comp Wa er ❑Encroachment Permit ❑Access Agreement '.Lead Agency Approval MFR COMMENTS/CONDITIONS: Cat )ullr'- �-c'r > c 1 e WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit ?rj 0 3 t-5 $179 x 5 ) '�.( �l t� t 1� 1,0 17 l(, 17 73 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 IF 209 464-0138 1 www.sjcelid.com EHD 29.01 07-01-2025 Site Mitigation Well Permit Application