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Job Address <br />Cross Street <br />1050 S. Diamond St. <br />Dr. Martin Luther King Jr. Blvd. <br /> <br />Property Owner* Diamond Foods, LLC. <br />Address 950 Howe Rd. City/State/Zip Martinez, CA 94553 <br />Consultant/Sub-Contractor ATC Group Services LLC LIcense# Phone <br />CONDUCTOR CASING El Yes f81 No <br />GROUT SEAL DEPTH 40-75 <br />GROUT SEAL PUMPED? 0 Yes IN No <br />CONSTRUCTION SPECIFICATIONS <br />BORING DEPTH 40-75 <br />DIA OF BOREHOLE 2" <br />CASING THICKNESS <br />BOLTED TRAFFIC BOX CI STOVE PIPE <br />0 MULTIPLE CASINGS 0 MULTI-LEVEL WELL CASING DIA <br />TYPE OF CASING: 0 STEEL 0 PVC 0 OTHER <br />Boring Dia: Casing Die: Casing Depth: <br />TREMIE TYPE TO BE USED: 0 AUGERS El HOSE fXI PIPE <br />(Note: Maximum Freefall Depth Is 30 Ft) <br />GROUT SPECIFICATIONS neat cement <br />Destruction Inspection By/Dates: AIM low Aft,bie 09//f • f a 10 ia-tk, <br />Facilltv/SIte Information <br />I . <br />frec'eft3eee: <br />SAUOAQUIN <br />COUNTY <br />Greatness grows here <br />Environmental Health Department <br />SITE MITIGATION WELL & BORING PERMIT APPLICATION <br />For Wells and Borings Used for Contaminant Investigations and Remediation <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br />48 Hours Advance Notice Required For All Inspections <br />Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. <br />This application is made in compliance with San Joaquin County Development Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. <br />City/State/Zip Stockton, CA 95205 (209) 951-2188 <br />APN 155-320-190 <br />(209) 951-2188 <br /> Phone (925) 313-5800 <br />(209) 579-2221 <br />C-57 Contractor Gregg Drilling & Testing, Inc. <br />Phone <br />Phone <br />Address 1050 S. Diamond St. City/State/Zip Stockton, CA 95205 <br />License# 485165 <br />Address 1117 Lone Palm Ave., Suite 201B City/State/Zip Modesto, CA 95351 <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br />TYPE OF WELUBORING <br /> <br />NUMBER INSTALLATION TYPE <br />1:1 MONITORING <br />EXTRACTION (Vapor/Water) <br /> 0 HOLLOW STEM <br /> 13 HAMMER/DRIVEN <br /> ID MUD ROTARY 0 SOIL VAPOR PROBE <br /> IX] PUSH POINT (GP/ CPT) 0 SOIL BORING <br />10 0 HAND AUGER IX] INJECTION *Soma*, Wane) <br /> 0 OTHER: El OTHER <br />15-d, 15-e, 154. I5-g, I3-d <br />13-e r 134, 13-9, I7-a, I7-h <br />DESTRUCTION WORK TO BE PERFORMED: <br /># WELLS TO BE DESTROYED <br />WELL IDs <br />GROUT SPECIFICATIONS <br />TREMIE TYPE TO BE USED 0 AUGERS 0 HOSE 0 PIPE <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY1 <br />0 OVER-BORE DIAMETER of inches to depth of feet <br />0 PRESSURE GROUT To depth of feet below surface <br />0 EXPLOSIVES From to feet below surface <br />0 MUSHROOM CAP 0 3 feet below surface or feet below surface if >3 feet <br />WELL/ SOIL BORING [Ds <br />COMMENTS: Ten temporary injection points to be installed according to Workplan for Additional Pilot <br />Injection Testing, dated April 30, 2018. <br />I)iereby certify that I am authorized to complete this application and that the work will be done In accordance with <br />San Joaquin County Ordinance Codes and Standards, and all other applic,able California laws. <br />Signed (../) /f_( Title/Company <br />Print Name LUC tct -e Date I <br />LIA-473 kz <br /> <br />T USE ONLY <br /> <br />c --x <br />.2.:4 275 / 9 <br /> <br />Application Accepted By: <br />Grout Inspection By/Dates: <br /> <br />Date Issued: <br /> <br />FA Name FA Address LOD S , ,i Kai Sk-- FA# OCIZjicizr PR# <br />S/ <br />os-tapn <br />-z5- ifid) FA PE 2-1 (70 WP Reviewed By L --)1/ Work Plan Date j <br />0 C-57 I:157 Authorization for Other to Sign Permit g‘rkers Comp 0 Workers Comp Waiver 0 Encroachment Permit 1:1 Access Agreement aLead Agency Approval EIMFR <br />COMMENTS/CONDITIONS: <br />WP TYPE PE SC FEE INFO AMT REMITTED CHECK* RECV'D BY DATE WELL PERMIT# INVOICE# <br />Permit Luc. -5,1 3 $152x 4) (-4s-f. i‘i'tig t-)( <br />4-4 <br />-Lk- 4 tc (i) e ov _391-,si <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 I F 209 464-0138 I www.sjcehd.com <br />EHD 29-01 08-01-17 Site Mitigation Well Permit Application ,h.re 2,0,3 5-4 (hay 5 fp-ts-6 )--)( WI/ g 41Z00 -111