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SAN _J O A Q U I N Environmental Health Department —COUNTY �crFoa' ; Great, , herr-. 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 Rough and Ready Island City/State/Zip Stockton, CA 95203 Phone (209) 946-0246 Cross Street W Fyffe Street 316 Fyffe Ave. APN 16203007 Property Owner* Port of Stockton Phone (209) 946-0246 �► —Address 2201 Washington Street City/State/Zip Stockton,CA 95203 Ow C-57 Contractor PeneCore Drilling License# 906899 Phone (530) 661-3600 Address 220 N East St City/State/zip Woodland,CA 95776 ,*Consultant/Sub-Contractor Geosyntec Consultants Inc License# Phone (916)205-6833 Address 3043 Gold Canal Drive. Suite#100 City/State/zip Rancho Cordova, CA 95670 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS 0 MONITORING 2 ® HOLLOW STEM BORING DEPTH See Attached ❑BOLTED TRAFFIC BOX 0 STOVEPIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 8-inch ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS 2"Sch 40 PVC TYPE OF CASING: ❑STEEL 0 PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes 0 No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Sparge.Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: 0 AUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs W-101 R,W-342R GROUT SPECIFICATIONS Neat cement grout-3gal water to one 471b bag of pordand cement DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED 2 0 OVER-BORE DIAMETER of 8 inches to depth of feet WELL IDs W-101,W-342 ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Neat cement groat-3gai water to one 471b bag of porgand cement ❑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: Wells W-101 and W-342 to be replaced. Old well casing will be destroyed,and new wells will be installed next to original location. See attached table for well information.All IDW will be hauled off by a hazardous waste certified company. 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 l /✓ Title/Company Scientist Geosyntec Consultants Print Name Jennifer Martin Date 8/1/2025 DEPARTMENT USE ONLY I I Application Accepted By: �� /�— Date Issued: ` i L L Grout Inspection By/Dates: Destruction Inspection By/Dates: Facili /Site Information _ FA Name /I ,a ret 1 t l Z FA Address W FA# J R# u I� FA PE �( �� WP Reviewed By ` Work Plan Date 3i71 aC-57 7 Authorization for Other to Sign Permit er's Comp ❑Worker's Comp aiv ❑Encroachment Permit ❑Access Agreement ad Agency Approval -MFR COMMENTS/CONDITIONS: �71 UL4 LV rAVL&Vt�,A S ci u t 4��,, G,vk WP TYPE PE SC FEE(INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# $179 x Permit 1-11 1 t OL 1868 E. Ha27ton Avenue I Stock on, California 95205 T 209468- 420 1 F 209 464-0138 wvtn/v.sjcehd.com EHD 29-0107-01-2025 Z04 -32,1457 Site Mitigation Well Permit Application