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SALMON Environmental Health Department <br /> I ' —COUNTY— <br /> f'tr,;� ,rA'' ureolness grows here. <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 24 Hours Advance Notice Required For All Inspections <br /> CALL (209) 953-7697 For INSPECTIONS <br /> Application is hereby made to San Joaquin County for a permit to construct and/or install the work described. <br /> This application Is made In compliance with San Joaquin County Development TIUe,Chapter 9-1116.3,and the San Joaquin County Well Standards. <br /> Jab Address 530E Lafayette St City/Statelzip Stockton, CA 95203 Phone 209-522-4119 <br /> Cross street S. American Street APN 149-09-502 <br /> Property owner, City of Stockton Economic Development Department Phone 209522 4119 <br /> Address 400 E Main Street, 41h Floor citylstatelzip Stockton. CA 95202 <br /> C-57 contractor Gregg Drilling LLC License# C57-1044468 Phone 926-313-5809 <br /> Address 950 Howe Road CllylStatelzip Martinez, CA 94553 <br /> Consuitantisub-contractor Ground Zero Analysis, Inc. License# PG: 5023 Phone 209-522-4119 <br /> Address 1172 Kansas Avenue citylstatelzip Modesto. CA 95351 <br /> CONSTRUCTION WORK TO BE PERFORMED: *Note: OHsite BodngsNVells Require Access Agreements or Encroachment Permits <br /> TYPE OFWELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOWSTEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE <br /> ❑ EXTRACTION(VaraiWale) p HAMMERNPIVEN CIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVELWELLCASING DIA <br /> ❑ SOILVAPORPROBE _❑ MUDROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER <br /> ❑ SOILBORING ❑ PUSH POINT(GP/GPn CONWCTOHCASING ❑Yes 13 No Baring qa Cmhv DU CmbVDeph <br /> ❑ WJECTIONIuse.a..mao ❑ HANDAUGER ORDUTSEALDEPTH TREMIETYPETO BE USED. DAIIGERS ❑HOSE ❑PIPE <br /> ❑ OTHER ❑ OTHER GROIRSEALPUMPEW ❑Yes ❑No pW:MahwmF1eel11P1130F0 <br /> WEW SOILBORING IDs %1 GROUT SPECIFlCATgNS <br /> 4 V - .,7-41/JI <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION I ETHOD: D 0ALL TH P L 5 f 00"`K <br /> #WELLS TO BE DESTROYED 2 IN OVERBORE DIAMETER of_I zinto <br /> nc todepth or 3 IeeY Y <br /> WELL IDs MW-88 and MW-SD [I PRESSURE GROUT Todepthof feel below surface i <br /> GROUT SPECIFICATIONS Neat Cement smut ®EXPLOSIVES Frombollam 10 o feetSeaw surface <br /> TREMIETYPE TO BE USED ❑I AUG'E•RSS [I HOSE I@PIPE MUSHROOM CAP ®3 feel below <br /> wssurfamor I Wittelowsudeoalf4fee1 <br /> M s'V <br /> COMMENTS: " S S NNT �5 I � ! w <br /> � 4bl,e I <br /> I hereby,cedlfy that 1 a authorized to complete this application and t the work YAR be done in accordancewlth <br /> San Joaquin ounty Ordinance Codes and Standards,and all other applicable California laws. <br /> Signed/l nUelCompany Prolecl Manager,Gregg Drilling,LLC <br /> I <br /> Print Name Ryan Lea Date 4129/2024 <br /> EPARTMENT USE ONLY �- <br /> Application Accepted By: Dale Issued: <br /> Grout inspection By/Dates: M S l <br /> Destruction Inspection By/ tea: <br /> F ISite Information LA <br /> , S h. P(4 ' <br /> FA Nam I Ire/Yyw. yV FA Address 3 ( O/l1 FA# I PR# �S <br /> FA PE Wp ReWewed By —VuWok Plan Dale - 'LQ Zb <br /> C-5/ ❑C-57AvftdzdwIorO0Wl0$en Pem,i1 ❑Wo,keesComp ❑WNWSComPYr"( WmenlPmNt ❑AaessAaeemonl eadAgmAppard R <br /> c6M ENrsrcoN morisC-, e4ACVO W— e_ <br /> 4t h4�5 Ill)q;n LA)d Tl <br /> IWPTYPEj PE I SC I FEE INFO JAMT REMITTED CHECK# RECV'D BY I DATE I WELL PERMIT# I INVOICE# <br /> Pe mil Z UZ ($ siB2x C C M301N I/+/ o $ <br /> CGS 180 fSsbl } <� � ebbb <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-013E-j 1$.sJcehd.Com <br /> EHD PeL17Ab2023 SRO MNdauon VAA PerrQ Appraemn <br />