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JI <VIN SANJOAQUIN 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 compllance with San Joaquin County Development Title,Chapter 9-1115.3. and the San Joaquin County Well Standards. Job Address Sidewalk in front of 636 E Lafayette Street ciy1State1Zip Stockton, CA 95203 Phone 209-5224119 Cross Street S. American Street APN 149-09-504 209-522-0119 Property owner CItV of Stockton Economic Development Department Phone Address 400 E Main Street,4th Floor chy/statetzip Stockton, CA 95202 C-57 Contractor Gregg Drilling LLC License# C57-1044456 Phone 925-313.5800 Address 950 Howe Road citylstatelzip Martinez, CA 94553 ConsuitanUSub-contractor Ground Zero Analysis, Inc. License# PG: 5023 Phone 209-522-4119 Address 1172 Kansas Avenue Icitylstatelzip Modesto. CA 95351 CONSTRUCTION WORK TO BE PERFORMED:*Note: O9sile Borings Wells Require Access Agreements or Encroachment Permits TYPE OFWELLISORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOWSTEM eORINGDFPTH ❑BOLTEDTPAFFIOBOX ❑STOVE PIPE ❑ EXTRACTION(VepoaWala) ❑ HAMMEWRNEN DIA OF BOREHOLE ❑MULTIPLE CASINGS O MULTIdEVELWELLCASING DIA ❑ SOILVAPORPROBE ❑ MUD ROTARY CASINGTHICKNESS TYPE OFCASING: OSTEEL ❑PVC ❑ OTHER ❑ SOILRORING ❑ PUSHPOINT(GPICPT) CONDUCTOR CASING ❑Yes ❑No Baring Dla Casap Dix CrAV Depft ❑ INJECTIONWbbeoamanel ❑ OTHER X3ER GROUT SEAL DEPTH TREMIETYPETO �� ❑ OTHER ❑ OTHER GROUTSEAL PUMPED? ❑Yes ❑No (Note:Mxdmum Freelal Depth Ia30 FQ VIEW SOIL BORING IDS GROUTSPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: Ec L AAPPLY) l #WELLS TO BE DESTROYED 1 IS OVER-BORE DIAMETER of Inchestodepthof 3 feet WELLIDs MW-10 ❑PRESSURE GROUT To depth of_feet below GROUTS CATIONS Neat cement grout ®EXPLOSIVES Fragbollom o_teelbelmsudace TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ®PIPE EIMUSHROOMCAP ®3 feet below surface or feelbelmsurraceif> feel „E b COMMENTS: I hereby certify that 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. Slgnetl�L Tille/Company Protect Manager,Gregg Drilling,LLC Pdnl Name Ryan Lea Dale 4129/2024 DEPARTMENT USE ONLY �{ Application Accepted By: Date Issued: / d /,>0-2 Grout Inspection By/Dates: old Desbuctionlnspection By/Dales: acill ISIte Information FA Name fMQf i <,S FAAddress V'W/pl FA# 521 PR# `J FAPE I WP Reviewed By I Work Plan Date 2 G57 0 C57Adafta6mfwOibs Io&p Pamk ❑woMees Camp ❑Wakens Cowwaher OacadmenlPemil ❑Aa Aweemanl add Wwal' / FR EN COM TSlCONDITIONS:,,�^ �'A Cr0 _/ �_ �, _r �-Q <.L(, ' t Jbtam„— `beeqMMt JWPTYPEJ PE I SC I FEE INFO AMTREMITTED CHECK# RECV'D Y DATE WELL PERMIT# Zl INVOICE# Permit qo 313 $152X (2 4�3-o WPooµ54aV 1868 E. Hazelton Avenue 1 Stockton, Califonia`462051 T 49 44201 F 209 464-0138 1 www.Lehd.com EHD2eai 7-at-]023 Site MBgallm Wel Ne Apprwam