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SAN : J 0A Q U I N Environmental Health Department <br />Q -+ 5' 12 t /� i <br />Greoroess grows here. v r <br />o� SITE MITIGATION WELL <br />& BORING PERMIT APPLICATION <br />For Wells and Borings Used for Contaminant Investigations and Remediation4t�� <br />NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED \ <br />48 Hours Advance Notice Required For All Inspections co Cvw�M�dl� <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 />Job Address 30600 Corral Hollow Road City/State/Zip <br />Tracy/CA/95377 Phone 209-346-3224 <br />Tracy Hills Dr APN 253-100-150 25310022 (based on work plan map Figure 1) <br />Cross Street Phone 925-983-9587 <br />Property Owner" Lennar Homes of California, Inc. <br />City/State/tip San Ramon/CA/94583 <br />Address 2603 Camino Ramon Suite 525 Phone 530-661-3600 <br />C-57 Contractor <br />PeneCore Drilling, Inc. License# 906899 <br />CI <br />Address 220 N. East Street tY!State/Zip Woodland/CA/95776 <br />Phone 714-371-1805 <br />Cons ultanUSub-Contractor Haley & Aldrich, Inc. License# <br />Address 2033 N. Main St. #309 City/State/Zip Walnut Creek/CA/94596 <br />CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings=ells Require Access Agreements or Encroachment Permits <br />TYPE OF WELL@ORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />❑ MONITORING ❑ HOLLOWSTEM BORING DEPTH 5.51tbgs ❑ BOLTED TRAFFIC BOX -LEV❑STOVEPIPE <br />❑ EXTRACTION (VaporNJater) ❑ HAMMERIDRIVEN DIA. OF BOREHOLE 3.25 In. ❑PE LTIPLE CASINGSINGS ❑ ST❑] MU❑IP E❑ OTHER <br />L WELL SING DIA <br />IM SOIL VAPOR PROBE 2 ❑ MUD ROTARY CASING THICKNESS NA Casing Oia: Gazing Depth: <br />❑ SOIL BORING ® PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes ® No BoGROUT SEAL DEPTH oring Dia- <br />EMIE - TO BE USED: ❑ AUGERS ❑ HOSE El PIPE <br />❑ INJECTION (AirSoerae Ozone) ® HAND AUGER GROUT SEAL PUMPED? ❑Yes ®No (Note: Maximum Freefall Depth is 30 Ft) <br />❑ OTHER ❑ OTHER <br />WELL] SOIL BORING IDs SGP -01, SGP -02. GROUT SPECIFICATIONS <br />DESTRUCTION WORK TO BE PERFORMED: <br />DESTRUCTION METHOD: (CHECK ALL THAT APPLY <br />I <br /># WELLS TO BE DESTROYED ❑ OVER -BORE DIAMETER of inches to depth of feet <br />WELL IDs ❑ PRESSURE GROUT To depth of feet below surface <br />ROUT SPECIFICATIONS C] EXPLOSIVES From to feet below surface <br />GE]GTYPE FI BE USED AUGERS ❑HOSE ❑PIPE MUSHROOM CAP E]3 feet below surface or feet below surface if >3 feet <br />R OUT <br />I hereby certify that 1 am authorized to complete this application and that the work will be clone to accoroanw wnwr <br />+att! Joaquin County Ordinance Codes and. Standards, and all other applicable California laws. <br />Title/Company mistant Project ManagedGeologist / Haley & Aldrich <br />SignedDate 6/17121 <br />Print Name Adam PiesVzerliewl P.G. <br />DEPARTMENT USE ONLY <br />JEFFREY WONG Date Issued: 8/4/2021 <br />Application Accepted By: L L�.:nt �� ? 1 ✓ r tk, :,\Vsi <br />Grout Inspection By/Dates: rtI 7� <br />Destruction Inspection By/Dates: <br />=a ilit /Site Information FA# FA0026659 PR# PR0547033 <br />FAName Lennar Hillview Development EFAAddjrMeSs30600 CORRAL HOLLOW J W Work Plan Date 6/30/2021 <br />FA PE 2950 vat MFR <br />❑ C-57 CS7 Authorization br Other to Sign Permit ❑ Worker's Comp ❑ Worker's Comp Waiver ❑ Encroachment Permit ❑ Access Agreement ❑ Lead Agency Appo <br />Submit report of findings per SJC Well Standards 13.7.2 <br />AMT REMITTED <br />CHECK# <br />RECV'D BY <br />DATE <br />WELL PERMIT* <br />INVOICE# <br />�� <br />JW <br />6/30/2021 <br />304 <br />WP TYPE PE SC FEE INFO <br />Permit 2905 313 x152 x <br />2 <br />com <br />1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209464-0138ialonW�Permit Ae�hd.tion <br />EHD 2"1 09-01-17 SR0083928 <br />Confirmation #: 127731394 <br />