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S A N J O AQ U I N Environmental Health Department ---COUNTY- - r '' Graolorss grows here. 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 appl1 ation is made In complian a with San J in County Devel ment Title, Chapter 9-1115.3, and the San Joaquin County Well Standards. �nxAres� pPIrvre 3 Z. i1Y S . B l Y�� Job Address Noseete eu.NOM eNaum:an,a0 term roea eM eeum er eClo Laxer MaN amel Clly/State0p Tracy,CA, 95304 Phone N/A Cross Street S. Bird Rd and BCID Lower Main canal APN 255-050-010-000 Property Owner* Banta-Carbona Irrigation District Phone (209)835-4670 Address 3514 W. Lehman Road City/State/zip Tracy, CA,95304 C-57 Contractor Eaton Drilling Co.LLC License# 133783 Phone (530)662-6795 Address 20 W Kentucky Ave#5837 CltylStatelZip Woodland,CA 95695 ConsultanblSub-Contractor California Department of Water Resources License# NIA Phone (916)653-5791 Address 715 P Street CltylStatelZip Sacramento, CA,95814 CONSTRUCTION WORK TO BE PERFORMED: *Note: O#site Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ® MONITORING 4.nested HOLLOWSTEM BORING DEPTH 1450 ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaparAValer) ❑ HAMMERIDRNEN DIA.OF BOREHOLE to in.to720.12 to To®MULTIPLE CASINfGTS❑MULTREVELWELL CASING DIA 2.51nch,SCH80 ❑ SOIL VAPOR PROBE I@ MUD ROTARY CASING THICKNESSSch.80 PVC TYPE OF CASING: 72A STEEL ®PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT( CONDUCTOR CASING ❑Yes 91 No Boring Dia: w Casing Dia: 2.5' Casing Depth: (see drawing) ❑ INJECTIONf0some.0mnel ❑ HANDAUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: [I AUGERS ❑HOSE Rl PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ®Yes ❑No (Note:Ma)dmum Freeing Depth is 30 Ft) WELD SOIL BORING to$ GROUT SPECIFICATIONS 10.3 sack neat cement DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of feet WELL IDs ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to_feel below surface TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE []PIPE MUSH OOM CAP 113 feet below surf ce or feet Nlow surface if>3 feel COMMENTS: �._/N.1a^2 C IC C 1CC >M , rQ L Il� R be i hereby certify that I am authorized to complete this application and that the work will be done in accordan avi ith � fir. n Joaquin County Ordinance Codes and Standards,and all other applicable California laws. ^y C4 e cc/ c'tkrn Signed ��: Title/Company Drilling Manager/Eaton Drilling o., LLC Print Name Mahlon Barklow Date 8/16/2023 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Date : Destruction Inspection By/Dates: Facllit /Site Information FA Name FA Address I)i�,� FA# " Yj PR# () Lill' FAPE Lq WP Reviewed By Work Plan Date - ; U F0 3 C57 G5 'u0on V Other to Sign Permit ❑Workers Camp ❑Workers Cornp Wavier ❑Encroachment Pem:it ❑Aoess Agreemen ❑Lead Agency Approval FR COM EN /CONDITIONS. AScv/ ;� r c L e of eV& rl't t{K s r�vL ,' e7trr� . 7 O S I,JQ 4LS (>itC aA; r< Se 2 ezan 1WQl(s A-D, as vve(f fo tlt9 s.( �e ;5 rz� u,fed. 6HD Muf4'tae k k LDAt(nL � yAR JA4 ( dS� d del•�ry +F 5gyl; C'Lr� seal, PIP r2�� r �o -HL2 Av52rfYe)' d WP TYPE1 PE I SC I INFO AMT REMITTED CHECK# RECV'D BY DATEI WELL PERMIT# INVOICE# Permit 2q0 3 6 x '1'b q8rr,, 4�)Y 2.3 11/r 70 �� b� 8�• 8 1868 E. Hazelton Avenue I Stockton, il60 nI 5 """ '"" "'"^ I F 209 464-0138 1 www.sjcehd.C1m EHD 29-01 0F20-23 — Site Mitigation Well Permit Application