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SAN JOAQUINp Environmental Health Department COUNTY \`r',t,rrt�/ Greotness prows herr SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings Used for Contaminant Investigations and Remediation NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 48 Hours Advance Notice Required For All 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 1624 Army Court City/State/Zip Stockton, CA 95206 Phone 209-601-8445 Cross Street West Charter Way APN 163-340-020-000 Property Owner* DPFI2 CA 18 Army Court, LLC Phone 209-604-8445 Address 2860 South River Road City/State/Zip Wayne,NJ 07470-2030 C-57 Contractor Penecore Drilling License# Phone 530-661-3600 Address 2.20 North Fast Street city/State/zip Woodland,CA 95776 Consultant/Sub-Contractor License# 906899 Phone Address City/State/Zip CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 12-14' ❑BOLTED TRAFFIC BOX ❑STOVEPIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: []STEEL WVC ❑ OTHER N SOIL BORING PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes o Boring Dia: 2" Casing Dia: 3/4" Casing Depth: 12' ❑ INJECTION(Air Sparge,ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE-ff PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs S$-1, SB-2 SB-3,SB-4,SB-5 GROUT SPECIFICATIONS —SB-6 DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDs ❑PRESSURE GROUT To depthof 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 T FPfflff R six geoprobe borings and tempoary wells set in two of the six borings. The wells will be consist of PVC scrn and riser and will not contain sand or bentonite, The PVC will removed the samen holes al d 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 vve� __40- Title/Company Project Manager,AECOM Print Name Tracey P. Gillespie Date 5/31/2019 DEPARTMENT USE ONLY Application Accepted By: � �"`fJhrw�� Date Issued: G AG/Lu/'' Grout Inspection By/Dates: / Destruction Inspection By/Dates: aJ�. ,e'7*t G— Y- 9 Facilit /Site Information FA Name FA Address �I(Ixj 4r m G FA# 00 Z 5-2 PR# .1 r/f,-/SO FA PE 216y WP Reviewed By Work Plan Date ❑C-57 C-57 Authorization for Other to Sign Permit 211orker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval IrMFR COMMENTS/CONDITIONS: 80. Cr,( Wss„?-L. /7,ft/ Ce"...-I o ,/•y U.+� .• ,��•�' �f , �n�•�i( . aor�5-j'.� A�r'�7��G,rd/�Yf� • �i✓�Z�r C.�v WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2je5 3/3 $152 x 3 V Vfle•W 10 A-A) wl:W31071 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com EHD 29-01 08-01-17 Site Mitigation Well Permit Application we PO••,, 2903 5y3 4/s;?x 3 �qy s6 av 9°999�g �/ /9 S/Z'VW'8068.8•