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SAN JOAQUIN Environmental Health Department COUNTY rr.n j Greotne55 grows here. 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 9-1116.3, and the San Joaquin County Well Standards. Job Address 10304 West Linne Road clty/state/zipTracy, CA 95377 Phone Not Provided Cross street South Tracy Boulevard APN 253-120-52 Property Cl SJ Land Management LLC Phone 925-699-9920 Address 4177 Churchill Drive City/state/zip Pleasanton, CA 94588. c-57 Contractor Environmental Control Associates, Inc (ECA)License# 695970 X'FV aI3�Phone 530-441-8393 Address 3011 Twin Palms Dr. city/state/zip Aptos, CA 95003 ConsultanUSub-ContractorPartner Engineering & Science, Inc License# N/A Phone 510 439-2639 Address 2154 Torrance Boulevard City/Statelzlp Tracy, CA 95377 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 20' 4 ❑BOLTEOTRAFFIC BOX STOVE PIPE ❑ EXTRACTION(Vapor/Water) 0 HAMMERIDRIVEN DIA.OF BOREHOLE 2.2 ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING CIA ❑ SOILVAPORPROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER t$ SOILBORING —4--® PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION IAkaoxae.omnel ❑ HANDAUGER GROUT SEAL DEPTH THEME TYPETO BE USED: [I AUGERS ❑HOSE [I PIPE ❑ OTHER ❑ OTHER GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Frcefall Depth is 30 Ft) WELUSOIL BORING IDs B1-1314 GROUT SPECIFICATIONS Neat cement rou via tr rnm i n' Aj:eM �a Y a i6 � SS � �� ?,�^ c0?�Ple y DESTRUCTION WORK TO BE PERFORMED: UCir 0 METRO CHECKALLT A APPLY ` �- #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of V L AI fee ' ' r C • Ly WELL IDs ❑PRESSURE GROUT To depth of feet below sudace o Revd r�l twt GROUT SPECIFICATIONS [I EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below sudace or feet below surface if>3 feet COMMENTS: Soil Vapor at 5.5' at each boring (4 total) 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_ Title/Company Project Manager/Partner Engineering & Science, Inc. Print Name Joe Mangine Dale 3/5/2024 vV DEPARTMENT USE ONLY 2 1 Application Accepted By: Date Issued: ' 1 oC ��L+ Jj Grout Inspection By/Dates: Destruction Inspection By/Dales: 3 , FacifliviSite Information FA Name FAAddress / (� 30 1,f Y1 FA# 0() Zg�q PR# p Cj 4-$9gj� FA PE `L� r 0 WP Reviewed By Work Plan Date `�02 ❑G-57 AG57Authodzallon for Other to Sign Permk ❑Workers Comp ❑Workers Comp Waiver ❑Encroachment Permit ❑Aooess Agreement ❑Lead Agency Approval Km,FR COMMENTSICONDITIONS 1 �1� 1�S I r/� D r� 4V G L/ j1 Re L Nda rd �j l� �1 2A{T (/T f 1� 7LJL/ WP TYPE I PE I SC FEE INNI AMT REMITTED CHECK#I RECV'D BY D TF WELL PERMIT# INVOICE# Permit 31 $162x 3 CC d I I W I 0(f, 13 eC F+ fi Ol 23 F> IL 2 SKOOB}gob 1868 E. Hazelton Avenue I Stgclst on Califf(orrni 952��T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29417-01-2023 C Lid Site Mitigation Well Permit Application