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0 ,OPaUrN SAN J OAQU ( N Environmental Health Department I" COUNTY Greotnnss ornwc here. SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED J 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 5300 W. Woodbridge Rd. City/State/Zip Lodi, CA 95242 Phone Cross Street N. Ray Road APN 01116025 Property Owner* Pacific Gas and Electric Phone 925-482-7606 Address 3401 Crow Canyon Rd. City/State/Zip San Ramon, CA 94583 C-57 Contractor Gregg Drilling License# 1044456 Phone 925.313.5800 Address 2100 Goodyear Rd. City/State/zip Benicia, CA 94510 ConsultantlSub-ContractorJacobs Engineering Group,Inc.(Jonathan Ferris)License# Phone 505-280-9088 Address 2101 Webster Street, Suite 1410 City/State/Zip Oakland, CA 94612 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(Vapor/Water) ❑ HAMMERIDRIVEN 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 Sparge,Ozone) ❑ 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 18 DQ OVER-BORE DIAMETER of 3.25 inches to depth of 10 feet WELL IDS Listed below in comments section ®PRESSURE GROUT To depth of up to 32 feet below surface GROUT SPECIFICATIONS Type 1/11 Portland Cement ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED [:]AUGERS C@ HOSE ®PIPE ®MUSHROOM CAP El3 feet below surface or feet below surface if>3 feet COMMENTS: PZ-1,PZ-2,SVE-1,MW-5,MW-12,MW-9,MW-6,MW-7,MW-13,MW-8,SVE-8,SVE-10,PZ-4,PZ-5,PZ-6 All wells listed above are located within 5 feet of known utilities and are to be destroyed by pressure grouting(required by Gregg Drilling and PG&E).If possible(no utilities within 2 feet),well boxes will be removed and mushroom cap will be placed to surface.SV-1,SV-2,SV-3 will be removed by air-knifing or hand auger to 10 ft(1/4"dia.tubing). I hereby certify that I am authorized to complete this application and that the work will be done in accordance with -7,� San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed ��ZG9dQ� Title/Company Gregg Drilling LLC. Print Name David Moses Date06/02/25 DEPARTMENT USE ONLY Application Accepted By: Date Issued:Al- Grout Inspection By/Dates: �1- Destruction Inspection By/Dates: Facili /Site Information FA Name Xc,�v FA Address 7 JJ w✓a �� FA# JO. � PR# v L 7 �� FA PE eft(�,v WP Reviewed By Work Plan Date S� ❑C-57 ❑C-57 Authorization for Other to Sign Permit Worker's Comp [I Worker's Mmp Waiver El Encroachment Permit Access Agreement mead Agency A prove l E*FR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2A,o.Z 3L3 $172 x 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-342(� F 209 464-0138 1 www.sjcehd.com EHD 29-01 08-01-2024 2,011 2('\L) Site Mitigation Well Permit Application