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SAN . JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Grentness grows her,. <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 24 Hours Advance Notice Required For All Inspections <br /> CALL (209) 953-7697 For INSPECTIONS <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. <br /> This application is made in compliance with San Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. <br /> Job Address 2880 INTERMODAL VVY MANTECA City/State/Zip MANTECA/CA/95330 Phone <br /> Cross Street TACTICAL WAY APN 198-200-22 <br /> Property Owner* SUNRISE TRUCKING Phone <br /> Address 865 E ROTH ROAD City/State/Zip FRENCH CAMP/CA/95231 <br /> C-57 Contractor CASCADE DRILLING License# 1058336 Phone 510-478-0858 <br /> Address 3459 COLLINS AVE City/State/Zip RICHMOND/CA/94806 <br /> Consultant/Sub-Contractor GEOSYNTEC CONSULTANTS License# Phone 480-540-5218 <br /> Address 801 5TH AVENUE SUITE 200 City/State/Zip SEATTLEANA/98104 <br /> CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br /> TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 25' ❑BOLTED TRAFFIC BOX ❑STOVE PIPE <br /> ❑ EXTRACTION(VaporMater) ❑ HAMMERIDRIVEN DIA.OF BOREHOLE 4.5" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA <br /> ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS N/A TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER <br /> ® SOIL BORING 8 ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: Casing Dia: Casing Depth: <br /> ❑ INJECTION(Air Sparae.Qz9ne) El HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE EyIPEt(�µ.�i�D <br /> OTHER El OTHER: GROUT SEAL PUMPED? ❑Yes ®No (Note:Mmnn, Freefdl Depth is 30 Ft) <br /> WELL!SOIL BORING IDs S-1,S-2,S-3,S-4,S-5,S-6,S-7, GROUT SPECIFICATIONSt� <br /> and S-8 <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLYI <br /> #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet <br /> WELL IDs ❑PRESSURE GROUT To depth of feet below surface <br /> GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface <br /> TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet <br /> COMMENTS: <br /> hereby certify that I am authorized to complete this application and that the work will be done in accordance with <br /> San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. <br /> Signed " ` `` Title/Company Principal/Geosyntec Consultants <br /> Print Name Wendy Key Date 1/15/2026 <br /> DEPARTMENT USE ONLY <br /> Application Accepted By: Date Issued: <br /> Grout Inspection By/Dates: <br /> Destruction Inspection By/Dates: <br /> Facilit /Site Information <br /> FA Name - FA Address FA# PR# <br /> FA PE WP Reviewed By Work Plan Date l <br /> ❑C-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR <br /> COMMENTS/CONDITIONS: I I n <br /> yvi� 17i�:w�\5 ln�tv166'LV � �ti�GSliWvLt <br /> WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# <br /> Permit 23a7 3t3 $172 x z� 5 3 �(, I W P XA14 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-.y3420 1 F 209 464-0138 ( www.sjcehd.com <br /> EHD 29-01 08-01-2024 .7, -7 ( l Site Mitigation Well Permit Application <br />