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A N P JUAQUIN Greatness gro>,vs here. Environmental Health Department SITE MITIGATION WELL & BORING PERMI I 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 Al install the work described. This application is made in compliance with San Joaquin County Development Title, Chapter 9A 115.3, and the San Joaquin County Well Standards. Job Address 4600 East Clark Drive Cross Street None - near Marfargoa FAI HE II LLC Road Property Owner Address 4600 East Clark Drive C-57 Contractor Neil O Anderson &Associates Inc. Address 10841 S. Ridgeview Road Consultant/S ub-Contractor Terracon Consultants, Inc. Address 902 Industrial Way CitylState/Zip Stockton, CA 95215 APN 179-220-11 City/State/Zip Stockton, CA 95215 License# 669004 CityJState/Zip Olathe, KS 66061 License# CityJState/Zi p Lodi, CA 95240 Phone Phone Phone 913-599-6886 Phone 209-367-3701 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELUBORIN_G_ ❑ MONITORING ❑ EXTRACTION (Vapor/Water) El SOILVAPORPROBE [Z SOIL BORING El INJECTION (Airsparne,ozone) El OTHER WELL/ SOIL BORING IDs NUMBER 3 ❑ INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS HOLLOW STEM BORING DEPTH 15 to 70 ft ❑BOLTED TRAFFIC BOX ❑STOVE PIPE HAMMERIDRIVEN DIA. OF BOREHOLE 6 inch ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER PUSH POINT (GP/ CPT) CONDUCTORCASING ❑ Yes ❑ No Boring Dia: Casing Dia: Casing Depth: HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE OTHER: GROUT SEAL PUMPED? ❑ Yes ❑ No (Note: Maximum Freefall Depth is 30 Ft) GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: #WELLS TO BE DESTROYED WELL IDs GROUT SPECIFICATIONS TREMIE TYPE TO BE USED ❑AUGERS [:1 HOSE [:1 PIPE COMMENTS: Signed DESTRUCTION METHOD: (CHECK ALL THAT APPLYI ❑ 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 ❑ 3 feet below surface or feet below surface if >3 feet 1 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. Title/Company Professional Geologist / Terracon Consultants, Inc. Print Name Tony Mikacich U Date February 18, 2022 Application Accepted By: Grout Inspection By/Dates: Destruction Inspection By/D G....i 1:4.•lC ion Infnrm otinn DEPARTMENT USE ONLY JEFFREY WONG Date Issued: 3/11/2022 FA Name Proposed Distribution Center FA Address 4522 and 4600 Marfargoa FA# 0027047 PR# 547551 FA PE 2950 WP Reviewed By JW Work Plan Date 2/22/2022 ❑ C-57 C-57 Authorization for Other to Sign Permit ElWorkers Comp ElWorker's Comp Waiver ElEncroachment Permit ElAccess Agreement ❑ Lead Agency Approval MFR COMMENTS/CONDITIONS: Submit copy of report testing results to EHD per SJC Well Standards 13.7.2 WP TYPE PE SC I FEE INFO JAMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 1$152 x 186o$°�fl�azeQton Ave nue�3�tockton, California 95205 � T 209 468-3420 � F 209 4�4=QT�849�7www.sjgov.org/ehd EHD 29-0i 06-28-21 Site Mitigation Well Permit Application 186o$°�fl�azeQton Ave nue�3�tockton, California 95205 � T 209 468-3420 � F 209 4�4=QT�849�7www.sjgov.org/ehd EHD 29-0i 06-28-21 Site Mitigation Well Permit Application