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RECEIVED FEB 0 2 2023 SAN-d0AQUIN Envir .nn��nne�ntal Health DepaH rtment QNFfI ONI\I I`NTAL lil'sAL ' —COUNTY— D4:P,1Rl'I\ICNT . :rrotness 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 9-1115.3, and the San Joaquin County Well Standards. Job Address 2154 S El Dorado Street City/Slate/Zip Stockton, CA 95206 Phone Cross Street 8th street APN 167-050-210-000 Propertyowner* Mr. Min Le of McBillin Real Estate Investment (McBillin) Phone (408) 893-1418 Address 3293 Napa Drive City/stale/zip San Jose, CA 95148 C-57 Contractor Penecore Drilling Inc. Licensert 906899 Phone (530)661-3600 Address 220 N East Street city/state/zip Woodland, CA 95776 Consultant/Sub-Contractor Apex Envirotech Inc License# 706181 Phone (916) 851-0186 Address 11291 Pyrites Way, Suite B city/State/ziP Gold River, CA 95670 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings]Wells Require Access Agreements or Encroachment Permits TYPE OF WELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOWSTEM BORINGDEPTH 26 ®BOLTEDTRAFFIC BOX ❑STOVEPIPE IM EXTRACTION(VawdWater) 3 0 HAMMERNRNEN DIA.OFBOREHOLE Ju, ❑MULTIPLE CASINGS MULTN.EVELWELL CASING DIA ❑ SOILVAPORPROBE ❑ MUD ROTARY CASING THICKNESS lA" TYPE OF CASING: El STEEL ®PVC ❑ OTHER ❑ SOILBORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No notes Dia: Casug Did: Cosing Depth: ❑ INJECTION IAt Seaga 0zorel ❑ HANDAUGER GROUT SEAL DEPTH 11-6' TREMIE TYPE TO BE USED: [I AUGERS ❑HOSE ❑PIPE ❑ OTHER Cl OTHER:SEE comments GROUT SEAL PUMPED? ®Yes ❑No (Note:Maximum Freefell Depth is 30 Ft) WELU SOIL BORING IDs \/W-1, \fW-2, \/W-3 GROUT SPECIFICATIONS Portland Iype II Cement DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED [I OVER-BORE DIAMETER of inches to depth of feel III WELL IDs ❑PRESSUREGROUT Todepthof fcetbelowsurrace GROUT SPECIFICATIONS [I EXPLOSIVES From to feelbelowsudace TREMIE TYPE TO BE USED []AUGERS []HOSE []PIPE [I MUSHROOM CAP ❑3feelbebwmu "or feet belowsurface If>3 feet COMMENTS:Wle intend to Incorporate the existing three(3)Vapor Wells(VW-1,VW-2,VW-3)Into our multi-phase extraction system.To do this,we plan to remove the well box and surrounding concrete without removing the environmental seal,tdm the blank portion of the well casing,and attach a 4"x 2"tee coupler.Then,an expandable well seal will be attached to the casing and the vapor extraction lines,groundwater pump return line,and air supply line will be fed through.Lastly,a resized well be) will be installed,and the concrete will be replaced to the surface.SEE Revised Remedial Action Plan dated 29 A dl 2022. 1 hop by ertify that I am authorized to complete this application and that the work will be done in accordance with /,r San Joaquin County Ordinance Codes and Standards,and all other00plicablp California laws. Signed /1'/J` , Titl ...pan. �I?�' i `,'f`r 'r Print Name Ian eA Vz 1- Date 1 19 D PARTMENT USE ONLY ^ / A 45/2- O Application Accepted By: / Date Is ad. `//�. (- Grout Inspection By/Date . Destruction Inspection By/Dales: Facilit /Site information FAName aj 4^ ro I FA Address I ?,15q 51 a I FA# O Ztrgjj I PRO 1 6. zfI FA PE O WP Reviewed By Work Plan Dale tT ZGZ 'Q'M ❑C57 7AuaMutiDnfa ONerlo Sign Perail ❑Workers Comp ❑Workers Coop Waiver ❑Encroachment Permit ❑Access Agreement ad AgencyApprovai R ACT yJ COMMENTSI ONDI ONS: _ /./�i�� V. . / ( -f r //� J ? Cl 3 �t W V t J �a Wile TYPE I PE F I SC F INFO JAMT REMITTED1 CHECK# I RECV'D BY I DATE I WELL PERMIT# INVOICE# � Permit 990 U 06r61 3 trt 0 S K 008 \ 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 WWW.sjcehd.com CF J EHD29-0104-04-07 I Cc (5 740 �� Site MitigaEon Well PermilAppliratim