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QUIry.. SQ N >10AQ U I N Environmental Health Department o COUNTY cFQa`'�r Greatness grows her. . 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, hapter 9-1115.3,and the San Joaquin County Well Standards. Job Address 5300 W. Woodbridge Rd. (54,29 W 0004V {1 /�QUip Lodi, CA 95242 Phone cross Street N. Ray Road APN 01101004 Property Owner* Union Pacific Railroad Phone Address 833 East 8th St. City/State/Zip Stockton, CA 95206 C-57 Contractor Gregg Drilling License# 1044456 Phone 925.313.5800 Address 2100 Goodyear Rd. City/State/Zip Benicia, CA 94510 Consultant/Sub-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) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOILVAPORPROBE ❑ 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 Soaree,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 6 ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDs AS-3,MWA0,MW-11,SVE-4,SVE-4,SVE-9 ®PRESSURE GROUT To depth of up to 32eet below surface GROUT SPECIFICATIONS Portland Cement Type 1/11 ❑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: 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(utilities not within 2 feet),well box will be removed,and mushroom cap will be added. I 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. Signed Z )ay G�i 7e&-d� Title/Company Gregg Drilling LLC. Print Name David Moses Date 06/02/25 DEPARTMENT USE ONLY Application Accepted By: � Date Issued: 24 2 Grout Inspection By/Dates: Destruction Inspection By/Dates: Facility/Site Information FA Name µ.j vtk5 r7�� _ AAddress - ��, Lv �� FA# Vv ik PR# FA PE v WP Reviewed By Work Plan Date 3 J&-57 ❑C-57 Authorization for Other to Sign Permit 1;rWorker's Cor^^ ❑Worker's&mp Waiver ❑Encroachment Permit Access Agreement 'Lead Agency Approval 1[(MFR COMMENTS/CONDITIONS: ��W WP TYPE PE Sc FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2`lvl 3t3 $172x v &L" ,,L, , no 71 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 08-01-2024 2.'o A)40 -Pf Site Mitigation Well Permit Application