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SAN JOAQUIN I i -COUNTY- - V Greatness grows here. • • , U •: ON I FITC MITIGATION WCL (k DORING 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 1904 West Charter Way cross street Tillie Lewis Drive CitylState/Zip Stockton/CA/95206 APN 163-020-41 Phone 5925) 278-8688 Property Owner* Glenn Springs Holdings, Inc. Phone (713) 366-5143 Address 5 Greenway Plaza, Suite 110 City/State/Zip Houston/TX/77046 C-57 Contractor PeneCore Drilling License# ell, (�( Phone (530) 661-3600 Address 220 N. East Street City/state/zip Woodland/CA/95776 Consultant/ Sub-Contractor Geosyntec Consultants, InC. License# Phone (925) 278-8688 Address 1340 Treat boulevard, Suite 208 _City/statelzip Walnut Creek/CA/94597 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ EXTRACTION (VaporllNaler) H SOIL VAPOR PROBE ElSOIL BORING ElINJECTION (Air Soarae, Ozone) ElOTHER WELLI SOIL BORING IDs ❑ HOLLOW STEM BORING DEPTHS' & 10' (2 of eac�j BOLTED TRAFFIC BOX ❑STOVE PIPE HAMMER/DRIVEN DIA. OF BOREHOLE 2.25" ❑ MULTIPLE CASINGS ElMULTI-LEVEL WELL CASING DIA 4 ElMUD ROTARY CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC F]OTHER ❑ PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes ElNo Boring Dia: Casing Dia: Casing Depth: ElHAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ElAUGERS [IHOSE ® PIPE ❑ OTHER: GROUT SEAL PUMPED? EJYes ® No Note: Maximum Freefall Depth is 30 Ft) GROUT SPECIFICATIONS A%,pi, 4� no'm � A� DESTRUCTION WORK TO BE PERFORMED: # WELLS TO BE DESTROYED WELL IDs GROUT SPECIFICATIONS TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE [:]PIPE COMMENTS: DESTRUCTION METHOD: {CHECK ALL THAT APPLY) ❑ OVER -BORE DIAMETER of inches to depth of feet ❑ PRESSURE GROUT To depth of feet below surface ❑ EXPLOSIVES From to feet below surface ❑ MUSHROOM CAP 1713 feet below surface or feet below surface if >3 feet A I hereby rtlfy that I am authorized to complete this application and that the work will be done in accordance with �% ��S,�n Joaquin County Ordinance Codes and Standards, and all other applicable California laws. Signed //yywf/ Print Name Ron Gestler Application Accepted By: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facility/Site Information Title/Company Senior Scientist, Geosyntec Consultants October 4 2021 Date , n � DEPARTMENT USE ONLY ate Issued: D FA Name C)A C ��,,,t FA Address ! (� � �i✓�, C. FA# L�-gQ9 PR# � � b FA PE � p WP Reviewed ey � � Work Plan Daie �� 3 Q �Z% ElC-57 ElC-57Authorization for Other to Sign Permit El Worker's Comp ❑ Worker's Comp Waiver El Encroachment Permit El Access Agreement El Lead Agency Approval El MFR COMMENTS/CONDITIONS: I` r pra! .L ir"Ot ee*0 ✓ek %H _ _ a ,�o C t Ltd j�n� s / _ �� rock, ,�o •vo.j � uvt'k r S'e'e I y 1P�. !�Lts 0,* f�.e vn�l -� �. �} ( j) WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE W LL PERMIT# INVOICE# Permit 'L�I��r ,� = 1$152 x - 6o g r r� C) / / (� �oy-Z Z � rf i � 17 s ,mo �nao d C �� t � 1 868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 � www.sjgov.org/ehd EHD 29-0106-28-21 Site Mitigation Well Permit Application