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SAN JOAQUIN Environmental Health Department COUNTY— Greatness 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 1601 Turnpike Road city/StatelZlp Stockton,CA,95206 Phone 209-327-7654 Cross Street South Lincoln Street APN NIA Property Owner- Steven Sangulnelti Phone 209-937-8249 Address PO Box 144,Linden,CA 95236 Clty/StatelZlp Stockton,CA 95202 C-67 Contractor Hammerhead Drilling,LLC License# 1066669 Phone (707) 332-0966 Address 11345 Trade Center Dr City/StatelZlp Rancho Cordova,CA 95742 ConsultantlSub-Contractor AdvancedGeo,Inc. License# 1063765 an Z/z Phone (800)511-9300 Address 837 Shaw Road CltylStatelZip Stockton,CA 95215 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offslte Borings/Wells Require Access Agreements or Encroachment Permits TYPE OFWELLIBORINO UN MBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOWSTEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVEPIPE ❑ EXTRACTION(Vep"Mate) 0 HAMMER,DRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LLVELWELL CASING DIA ❑ SOILVAPORPROBE ❑ MUDROTARY CASING THICKNESS TYPEOFCASING: ❑STEEL ❑PVC ❑ OTHER 7Q.Qi ❑ SOILBORING ❑ PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yes [I NO Boring Dia: Casing Dia: CVAV Depth: ❑ INJECTION IAYaoeaeenvrel ❑ HANDAUGER GROUT SEAL DEPTH TREMIETYPETOBEUSER []AUGERS❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUTSEAL PUMPED? WELDSOILBORINGIDs GROUT SPECIFICATION We: All 3/4-inchwells will be destroyed usiri wireline Wa explosives— DIpul er c ilia e iceLk DESTRUCTION WORK TO BE PERFORMED: # DESTRUCTION ME OD: ECIA•LL T APPL 0 7"t A+n/K7S WELLS To BE DESTROYED Twenty Eight(28) [)Q OVER-BORE DIAMETER o 4 S 10 nchw to depth of 5.20.30.32.35.65.66&120 feet WELL IDs MW-1 through MW-11 0-1 through 0.13,SV-1,SV-2,SV5,SV-6 ❑PRESSURE GROUT To depth of_ eel below surface ) GROUT SPECIFICATIONq Portland( Ilcemen osu ace rade [I EXPLOSIVES From_to_feet belay surface TREMIE TYPE TO BE USED . AUGERS ❑HOSE P ❑MUSHROOM CAP ❑3 feet balm surface or_feel below surface if>3 feel COMMENTS: An eqy vAbeoverddlledloNp Idal depths oK 20 32.35,65,0 am fmfeet sa art Ne grpuM wM• '- ore Bea to Nan 6ga1ons per9/yW,serJc. AMU tA6A7 at4A►tatlts( w/ 8' 'fe, d :siwk G— 1� .A , gV. "r,s..�usedl0"11SA , ��✓/ (kbvty IASQd �" 415�,4- OZOk ellsw+10 ', Sixd;4m&rfl atc�f_`rP&fjri1(iNgSl mtt,1- # 44CO3rfi r5A'f(22 'l>4A&ymjKiAt111 i hereby certify that I am authorized tel compleld is application ana that nrn ,.,,..,...._.._.V.---_.Jance with z San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. Akso � Signed 1 ,, Title/Company Staff Scientist/AdvancedGeo, Inc. Wofl�- 4l4ny Print Name Maxwell Niemeyer Date April 2024 2 D ART N SE ONLY '2n Application Accepted By: a Issued:(/ � I Ito 'C0y( Grout Inspection By/Dates: V Destruction Inspection By/Dates: Facilit /SI a Information FA Name emsq Yo FAAddresi, I f aryl A e FA# 60 2, PR# 5y' - FA PE 2"1 60 WP Redawed By Work Plan Dale 10 3 / 2 0 2 c57 ❑C57AUtt ibtation factor to Sign Permit ❑Workers Cmp ❑Worker's Comp Waiver ❑Enmoadmem Permll ❑A=sAgreenent Lead AgegApproval FR COM ENTSICONDITIONS: -f ;S .Y r'Oy�V-,� JQf- 'tou:ry �fTl : 11r �� bi�lti.� l� mfk- d�-to Afnl : s 4kJL mk0AfrAJ&- Rai 4k 1P 461 WPTYPEj PE SC I FEE INFO JAIMIT REMITTED1 CHECK# I RECV'D BY I DATE I WELL PERMIT# I INVOICE# Permit 2905 $162x5=$810.0 Q 1 eC- emu, lr-jb� VFI)D CC- ( _im ,j 3 2,5 SRo08+93(.s 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com EHD 2"17.01-2023 Site Mitigation Well PamJt Application