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SAN JOAQUIN p Environmental Health Department CCCUN y 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 1320 West Weber Avenue (near) City/State/Zip Stockton,CA 95203 Phone 209-948-0793 Cross Street West Washington Road APN 145-190-120 (no situs address for this APN) Property Owner* Stockton Cold Storage,LLC;ATTN Matt Burke UNION PACIFIC, CORPORATION for this APN Phone 562-965-1036 Address 1320 West Weber Ave, 1400 DOUGLAS ST STOP 1610 ONIAHA,NE 6S171) CitylState/Zip Stockton,CA 95203 C-57 Contractor PeneCore Dulling License# 906899 Phone 530-661-3600 Address 220 N.East St City/State/Zip Woodland,CA 95776 Consultant/Sub-Contractor Rincon Consultants,Inc. License# Phone 916-264-9764 Address 4825 J Street,Suite 200 City/State/Zip Sacramento,CA 95819 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 5'bgs/20'bSLJ BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA,OF BOREHOLE 2^ ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA El SOIL VAPOR PROBE 1 ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER El SOIL BORING —a—TO PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Sparse,ozone) El HAND AUGER GROUT SEAL DEPTH 5'bgs TREMIE TYPE TO BE USED: ❑AUGERS ❑ HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes IN No (Note:Maximum Freefall Depth is 30 Ft) WELD SOIL BORING IDs SB-01;SB-02;SB-09 GROUT SPECIFICATIONS HYDRATED MEDIUM BENTONITE CHIPS Revised per Daniel 10-!1 2A_?1 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.s& ❑ PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATION BEhIT9N E GROUT ❑ EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED Lj AUGERS HOSE ❑ PIPE ❑ MUSHROOM CAP ❑ 3 feet below surface or feet below surface if>3 feet COMMENTS.A TOTAL OF 3 BORINGS WILL BE ADVANCED. BORINGS SB-01 AND SB-09 WILL BE DRILLED VIA HAND AUGER TO 5'BGS,A TEMPORARY SVP WILL BE CONSTRUCTED IN SB-01 AND REMOVED DAYS AFTER SAMPLING. BORING SS-02 WILL BE DRILLED TO FIRST ENCOUNTERED GROUNDWATER(-20-25'BGS)AND A GRAB GROUNDWATER SAMPLE WILL BE COLLECTED USING CLEAN AND DISPOSABLE SCH 40 PVC BLANK CASING WITH SLOTTED SCREEN ATTACHED.ONCE THE GW SAMPLE IS COLLECTED,PVC WILL BE REMOVED AND THE BORING WILL BE GROUTED USING A TREMMIE PIPE FROM TD TO SURFACE. 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_ Zdd- -011t"L Title/Company Senior Program Manager,Rincon Consultants,Inc. Print Name UJulie Doane-Allmon Date September 30.2021 DEPARTMENT USE ONLY Application Accepted By: JEFFREY WONG Date Issued: 10/1/2021 Grout Inspection By/Dates: Destruction Inspection By/Dates: n r Zt% Facilit /Site Information FA NameTOCKTON COLD STORAGE FA Address 1320 W. WEBER FA## FA0026813 PR# PR0547236 FA PE 2950 WP Reviewed By JW Work Plan Date 9/30 20?1 ❑C-57 0 C-57 Authorization for Other to Sign Permit ❑Workers Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑ Lead Agency Approval Cf MFR COMMENTS/CONDITIONS: SUBMIT A COPY OF THE TEST RESULTS/REPORT TO EHD PER SJC WELL STANDARDS 13,7.2 WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 1; $152 x 3.75 570 cc r 0/1/2021 WP0042606 confirmation Number 132586384 SR0084300 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd EHD 29-01 OS 28-21 Site Mitigation Well Permit Application