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SAN JUAWN <br />C O U 1\1 T Y--- * <br />{�i�lotnrjss iir':);•r> �tC`rC. <br />SITE MITIGATION WELL Ck BURING PERMIT APPLICATION <br />NON-REFUNDABLE PERMITTEXPIRES 1 YEAR FROM DATE ISSUED <br />24 Hours Advance Notice Required For All Inspections <br />CALL (209) 9537697 For INSPECTIONS <br />Application Is hereby made to San Joaquln 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 <br />cross Street <br />1111 Navy Drive <br />Argonaut Street <br />Property Owner' Brendan <br />CttylStatelZtp Stockton I California 195206 <br />APN 163-260-070.000 <br />Address 1111 Navy Drive GitylStatelZtp Stockton I California 195206 <br />C-57 Contractor _ AdvancedGeo, Inc License# 1063765 <br />Address 837 Shaw Road <br />ConsultantlSub•Contractor Slagle Drilling Corporation <br />Addross 11345 Trade Center <br />Phone 209-474-1245 <br />Phone 209-474-1245 <br />Phone 209-467-1006 <br />City/StatelZlp Stockton /California / 95215 <br />License# 1046151 Phone 916-363-9355 <br />State/Zi <br />p Rancho Cordova /California / 95742 <br />CONSTRUCTION WORK TO BE PERFORMED: 'Note: offsite [3oringslVllells Require Access Agreements or Encroachment Permits <br />TYPE OFWELL/BORING NUMBER <br />INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br />❑ h10NITORING ❑ HOLLOy/ STEh1 BORING DEPTH ❑ BOLTED TRAFFIC BOX ❑ STOVE PIPE <br />ElEXTRACTION (VaporMater) ❑ HAMMER/DRIVEN DIA. OF BOREHOLE ElMULTIPLE CASINGS ❑ MULTI•LEVEL WELL CASING DIA <br />El SOILVAPORPROBE ❑ MLID ROTARY CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER <br />ElSOIL BORING ❑ PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes C1No Boring Dia: Casing Dia: CasN Depth: <br />ElINJECTION (AY Soarga, otanel ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE [IPIPE <br />❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑ Yes ❑ No (Note: Maximum Freefall Depth Is 30 FI) <br />WELUSOIL BORING IDs GROUT SPECIFICATIONS <br />DESTRUCTION WORK TO BE PERFORMED: _DESTRUCTION METHOD: (CHECK ALL THAT APPLYI <br />II WELLS TO BE DESTROYED Three (3) ❑OVER BORE DIAMETER of 2 inches to depth of feet <br />WELL IDs IrMr•1, M*2, and IAV' 3 0 PRESSURE GROUT To depth of 30 feet below surface <br />GROUT SPECIFICATIONS Portland Type II cement to surface grade ❑ EXPLOSIVES From to feet belau surface <br />TREMIE TYPE TO BE USED [IAUGERS ElHOSE p PIPE ElMUSHROOM CAP El3 feet belay surface or feet belay surface if >3 feet <br />COMMENTS: <br />hereby certify that I am authorized #o complete this application and that the work will be done in accordance with <br />�S�an Joaquln County Ordinance Codes and Standards, and all other applicable California laws. <br />Sfgned1•y ,tN� ' h�'ti ��� Title/Company Staff Scientist / AdvancedGeo, Inc <br />Print Name Maxwell Niemeyer <br />Application Accepted By: <br />Grout Inspection 6y/Dates: <br />Destruction Inspection By/Dates: <br />FA Name ove,�, r /'k C' <br />57 ❑ C•57Aulhoriza5on for Other to Slgn Permit <br />OMMENTS/CONDITIONS:�r� <br />1868 E. Hazelton Avenue <br />EHD 29-01 04-04-07 <br />FA Address <br />WP Reviewed By <br />Date 22 July 2022 <br />0.� <br />Y <br />Dale Issued: <br />FAIT <br />Work Plan Data <br />❑ lyorkels Comp ❑ Yrorker's Comp Waiver ❑Encroachment Permit ❑Access Agreement <br />Stockton, Ca <br />e S� ►'�-� OYl�vac <br />ornia 95205 <br />T 209 468-3420 � <br />PRI; <br />lead AgencyApproval <br />209 464-0138 � www <br />Silo hliBgation Well Pc <br />sjcehd.com <br />mil ApN;gtton <br />