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MW-11, MW-12, MW-13, & MW-17 °P SA N 10AQ U IN Environmental Health Department COUNTY °`trFoaa` Greatness grows her, . 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 2500 Navy Dr. City/State/Zip Stockton,CA 95206 Phone (209)937-8700 Cross Street APN 163-330-03 Property Owner' City of Stockton Municipal Utilities Department Phone Address 2500 Navy Drive City/State/Zip Stockton,CA 95206 C-57 Contractor Cascade Drilling License# C-57#1058336 Phone (707)378-3768 Address 3459 Collins Ave. City/State/Zip Richmond,CA 94806 Cons ultant/Sub-Contractor Condor,Casey Kipf License# CHG#1011 Phone (209)969-2034 Address 188 Frank West Circle,Suite I City/State/Zip Stockton,CA 95206 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 ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VapodWater) ❑ HAMMERIDRIVEN 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 Soarae.ozone) ❑ 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) WELL/SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED 4 groundwater monitoring wells ®OVER-BORE DIAMETER of 12 inches to depth of 3-5 feet WELL IDs MW-11 MW-12 MW-17 O PRESSURE GROUT To depth of 20-25' feet below surface'pressure grout to total well depth GROUT SPECIFICATIONS eat deT, [I EXPLOSIVES From to feet below surface TREMIE TYPE TO BE US _L219UGERS ❑HOSE ®PIPE ®MUSHROOM CAP ®3 feet below surface or feet below surface if>3 feet COMMENTS: Monitoring wells to be destroyed in accordance with the Monitoring Well Destruction Workplan dated 10/3/2025,approved by the Central Valley Regional Water Quality Control Board on 12/18/2025. 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 Title/Company Condor Earth Print Name Cas y kipfz Date 2/13/2026 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: El lq= Facility/Site Information FA Name � w,' A Address �;-u 0 U r I FA# ( PR# FA PE 2 i1 WP Reviewed By Work Plan Date ❑C-57 IBC-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ''Access Agreement &Zead Agency Approval IffWR COMMENTS/CONDITIONS: WP TYPE PE Sc FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit Lvtol -�[� $179, Gt 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 07-01-2025 �I/ 7'<2'�3 Site Mitigation Well Permit Application