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SAN JUAUUIN COUNTY Greatness grows here, Environmental Health Department 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 1601 Turnpike Road City/State/Zip Stockton, CA 95206 Cross Street Lincoln Street Property Owner* Steven Sanguinetti Address Mn C-57 Contractor AdvancedGeo, Ino. Address 837 Shaw Road ConsultantlSub-Contracto�gtfRg ConeTec FMri _ .�-�9eaiRa�r��tawa@ � 820 Aladdin APN 165-040-130-000 � F504013 City/State/Zip Linden, CA 95236 License# 6eo227 City/State/Zip Stockton, CA 95215 Maitinez CA City/State/Zip Phone (209) 327-7654 Phone (209) 327-7654 Phone (209) 467-1006 510 357-3677 no n 1049248 Phone—faee an Leandro, CA 94577 S Revised per CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits Evan Schmidt TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS 10/7/2021 ElMONITORING ❑ HOLLOW STEM BORING DEPTH 70-120 feet ElBOLTED TRAFFIC BOX ❑ STOVE PIPE ElEXTRACTION (Vapor/Water) ❑ HAMMER/DRIVEN DIA. OF BOREHOLE 2 inches [:1MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA ElSOIL VAPOR PROBE ElMUD ROTARY CASING THICKNESS TYPE OF CASING: ElSTEEL El PVC ElOTHER ElSOIL BORING 3 ® PUSH POINT (GP/ CPT) CONDUCTOR CASING ElYes ® No Boring Dia: Casing Dia: Casing Depth: ElINJECTION (Air Sparge, Ozone) ElHAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS [IHOSE ❑ PIPE ❑ OTHER ElOTHER: GROUT SEAL PUMPED? ElYes ® No (Note: Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs CPT-1A1CPT-1B, CPT -1C GROUT SPECIFICATIONS PORTLAND TYPE II CEMENT TO SURGACE GRADE must be tremmied if GINs DESTRUCTION WORK TO BE PERFORMED: #WELLS TO BE DESTROYED WELL In GROUT SPECIFICATIONS TREMIE TYPE TO BE USED ElAUGERS [:1HOSE ❑ PIPE C; GIIGUCTIILLTe� UCTION METHOD: (CHECK ALL THAT APPLY) UMMtN 15: CPT -1A will be drilled to 120 feet bsg for litologic classification. DESTR ❑ 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 El3 feet below surface or feet below surface if >3 feet CPT -1B will be drilled to 75 feet bsg for grab groundwater sampling. CPT -1C will be drilled to 120 feet bsg for grab groundwater sampling. Borings within a few feet of eachother. I hereby certify that l 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. Signed Print Name Evan Schmidt Title/Company Staff Geologist, AdvancedGeo, Inc. Date September 3rd, 2021 DEPARTMENT USE ONLY Application Accepted By: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facility/Site Information TEFF /16/2021 FA Name LOPEZ PROPERTY FA Address 1601 TURNPIKE FA# FA0023498 PR# PR0541037 FA PE 2960 WP Reviewed By JW Work Plan Date 4/ 14/2021 X C-57 ❑ C-57 Authorization for Other to Sign Permit ❑ Worker's Comp ❑ Worker's Comp Waiver ❑ Encroachment Permit ❑ Access Agreement gLead Agency Approval MFR COMMENTS/CONDITIONS: Submit a copy of the report/results to EHD per SJC Well Standards 12.7.3 WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2905 1 313 1$152x 3 456 CC JW 1 9/14/2021 WP0042552 confirmation�ation number; 13,1227178 SR0084223 1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 � F 209 464-0138 1 vvww.sjgov.org/ehd EHD 29-01 06-28-21 Site Mitigation Well Permit Application