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SAN JOAQUIN Environmenoa ➢ Health Debi cinrfllr� E:� COUNTY 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 COS ROW to 715 North Hunter Street City/State/Zip Stockton , CA Phone 209 '937-8444 Cross Street Park Street APN 139-054-090-000 Property Owner* City of Stockton Phone 209-937-8444 Address 425 North EI Dorado Street CitylState/Zip Stockton , CA 95202 C- 57 Contractor AdvancedGeo , Inc. License# 1063765 Phone 209-467" 1006 Address 837 Shaw Road City/State/Zip Stockton . CA 95215 Consultant/Sub -Contractor. Slagle Drilling Corperation License# 1046151 Phone 916 -363-9355 Address 11345 Trade Center Drive CitylState/Zlp Rancho Cordova , CA 95742 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 (VaporlWater) ❑ HAMMERlDRIVEN 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 Sa=e. azonei ❑ 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 Fourteen ( 14 ) 0 OVER-BORE DIAMETER of $- 10 inches to depth of 40-103 feet WELL IDs "�f�-t . "rvc. P rr `3• Prvs, P ,v n, rr•N. , P.r,v�s, ,°f. , u, t,v. , t , :rr . . .� -t , [I PRESSURE GROUT To depth of feet below surface GROUT SPECIrr FICATIONS Portland type II cement to surface grade [I 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 COMMENTS : "1VV-1 through MW 3, PAW- r ugh MVV 2. MVV 2 Mw-13, and "IVV45 will be over-drilled tb 40'Veet bsq using 8-inch augers. DPE4 wig over drilled tA40fAetbsg usi 0 i ge = _— Pd W-1 (62 feet Mw-i 1 feet) and MV%�114 (62 fee will be over over-drilled with S inch augers I hereby certify that I am authorized to complete this application and that the work will be done in accordance with Sa ,dpaquin County Ordinance Codes and Standards, and all other applicable California laws . Signed /� (` Title/Company Senior Geologist AdvancedGeo , Inc. Print Name Daniel Villanueva Date 04 May 2022 DEPARTMENT USE ONLY A Application Accepted By : Date Issued : fZ Grout Inspection By/Dates : Destruction Inspection By/Dates: Facili /Site Information FA Name Nj FA Address / / A# ® � 4 PR# ��40 FA PE WP Reviewed By Work Plan Date ❑ C-57 -57Authodzation for Other to Sign Permit ❑ Worker's Comp ❑ Worker's Comp Waiver ncroachment Permit ❑ Access Agreement ad Agency , MFR COMMENTSI NDITIONS : � 0 ?"'Q a J<8 en -�Pf, � C o-, {0 WP TYPE PE SC FEE INFO JAMT REMI CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit ®Z- $ 152 x `� � u/ / Z 3 30 00 , 1868 E . Hazelton Avenue Stockton , Cali ornia 95205 T 209 468 - 3420 ( F 209 464 - 0138 1 www . sjcehd . com EHD 29-01 044)4-07 Site Mitigation Well Permit Application I