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SAN JOAQUIN Ena, ronrnannL-t0 Hezdd Da,-Fjo —Cour:-v cr'.I ,r 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 1607 Turnpike Road (on-site wells) City/State2lp Stockton,CA Phone (209)466-4601 Cross Street South Lincoln Street APN 165-040-040-000 Property Owner" Dustin and Kristen Saccone Phone (209)940-7114 Address P.O.Box 710 CitylState/Zip Stockton,CA,95201 C-57 Contractor AdvancedGeo,Inc. License# 1063765 Phone (209)467-1006 Address 637 Shaw Road City/State/Zip Stockton,CA 95215 ConsultanVSub-Contractor Slagle Drilling Corporation License# 1046151 Phone (916)363-9355 Address 11345 Trade Center Drive City/State/Zip Rancho Cordova,CA 95742 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite BoringsANelis Require Access Agreements or Encroachment Permits TYPE OF WEWBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapof/Waler) 0 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 Boling DW: casing Dia Casing Depth: ❑ INJECTION(Air smae.Omne) ❑ HANDAUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 FQ WEW SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD:(CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED Nineteen(19) I] OVER-BOREDIAMETER of 8-10 inches to depth of 118 feet WELL IDs^M`1.ue++•M,va•Ms+^re•xrv+aua.x^v-roaauxnes.um-fue,ww-n,Mnu,oc-teu.wEtma oPex ❑ PRESSUREGROUT Todeplhof_feet below surface GROUT SPECIFICATIONS Portland type 11 cement t0 surface grade ❑EXPLOSIVES Fmm_lo_ feetbdowsudace TREMIE TYPE TO BE USED DAUGERS []HOSE ❑PIPE EI MUSHROOM CAP 713 feet below surface or feet below surface if>3 feet COMMENTS: Mw�and MW8 ihmugh MW-14 will be ovwdNled to between W and 118 feel bsg using 84nch augers. EX-1,FX-2,DPE-1,and DPE-2 will be overddiled between 30 and 45 feel beg using 104ric1h augers. 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 Cal-rfomia laws. Signed ft .�.. Y � Titre/Company Staff Scientist AdvancedGeo, Inc. Print Name kyiie Kucera Date 28 October 2022 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facility/Site Information FA Name FA Address FA# PR# FA PE I I WP Reviewed By Work Plan Date ❑C-57 0C-57 Auhod2adon for Other to Sign Permit ❑Workers Comp ❑Workets Comp Waiver ❑Encmachmenl Penna ❑Access Agreement ❑Lead AgencyApproval ❑MFR COMMENTS/CONDITIONS: WP TYPE I PE I SC I FEE INFO JAMT REMITTED CHECK#I RECV'D BY DATE WELL PERMIT# INVOICE# Permit $152 x 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01�7 Slle Mitigation Well Pwmit ApplicaCan