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SAN JOAQUIN Environmental Health Department COUNTY 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 308 N. Grant Street f (y5 %7,v W City/State/Zip Stockton, CA 95202 Phone (209) 463-9255 cross street N. Grant Stand E Miner Avenue APN 139-320-130 , (VC 1i'Llp�J Property Owner* Donna Skobrak Phone (209) 465-2667 Address 706 N. El Dorado Street City/State/Zip Stockton, CA 95202 C-57 Contractor V &W Drilling Inc License# 720904 Phone (209) 469-7700 Address 1133 BLACKHURST DR City/State/zip GALT, CA 95632 Consultant/Sub-Contractor Tylor McMillan's Well Service, LLC License# N/A Phone (916) 761-5224 Address 9530 Hageman Rd Ste B349 City/State/Zip Bakersfield, CA 93312 CONSTRUCTION WORK TO BE PERFORMED:'Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporlWater) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ 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 Soarae,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 28 ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDs See attached flgure ®PRESSURE GROUT To depth of 6.5-120 feet below surface GROUT SPECIFICATIONS ®EXPLOSIVES From 36 to 121 feet below surface TREMIE TYPE TO BE USED El AUGERS ❑HOSE ®PIPE MUSHROOM CAP G4.3 feet below surface or feet below surface if>3 feet COMMENTS: vvk7wCtn tc?5 r.L .' 1 {-5u04'r l� > pcov' (-o Cvu-twt.It-Clu k"' - Well destruction at the property located at 308 N Grant St(APN 139-320-130),associated with multiple addresses including 308 N Grant St&825 E Miner Ave Destruction of 6 wells via pressure grout method,17 wells via explosives and 5 wells via deviated/modified destruction methods.See figure and workplan I hereby certify that I am authorized to complete this application and that the work will be done in accordance with p San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed_�NF- - Title/Company PG#6795/Condor Earth Print Name John Lane Date February 23,2026 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facili /Site Information FA Name S -U ,Ica'J FA Address O' -`Lµ FA# PR# FA PE WP Reviewed By Work Plan Date ❑C-57 57 Authorization for Other to Sign Permit Workers Comp ❑Workers Comp Waiver PEncroachment Permit Access Agreement ead Agency Approval MFR COMMENTS/CONDITIONS: �,� �c, p.� Z� Ll� �iLw.fr�, t (- ! -S a><-{ c Chu S✓u-L WP TYPE PE LSC FEE INFO AMT�rREMITTED CHECK# RECV' BY DATE WELL PERMIT# INVOICE# Permit 7�oZ 3l'S $179 x < 111 C,(— 3-u-xp 54 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 20�68�6 20 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 07-01-2025 Site Mitigation Well Permit Application zti 1-I-`7,li