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SA N 0 A Q U IN Environmental Health Department COUNTY `CSCiP, Greatness !LOWS �jnrp 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 622 E Charter Way City/State/Zip Stockton, CA 95206 Phone Cross Street S American St APN 167-150-/49, 167-150-150, 167-150-/51 Property Owner*Joel Sanchez and Manuel Cruz Lazo/DTSC Project Manager-Stacy Mann Phone 279-895-5016 Address 622 E Charter Way City/State/zip Stockton, CA 95206 C-57Contractor PeneCore Drilling License# 906899 Phone 530-661-3600 Address 220 N. East St City/State/Zip Woodland, CA 95776 Consultant/Sub-ContractorAECOM Technical Services, Inc License# 641639 Phone 834-209-1534 Address 2020 L St, Ste 400 City/State/Zip Sacramento, CA, 95811 CONSTRUCTION WORK TO BE PERFORMED:`Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 5 and 15-feet ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ZZ ❑ EXTRACTION(VaporMater) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 3 1/4 inches ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA �2 0 SOILVAPOR PROBE ❑ MUD ROTARY CASING THICKNESS 2 inches TYPE OF CASING:❑STEEL ®PVC ❑ OTHER ( ❑ SOILBORING ® PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No Bodng Dia:3 1/4 inchesCasing Dia: 2 inches Casing Depth:5 and 15-feet ❑ INJECTION(Air Sparge.Ozone) ® HAND AUGER GROUT SEAL DEPTH 3'� r TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE M PIPE [I OTHER ❑ OTHER: GROUT SEAL PUMPED? M Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) 1 �i WELL/SOIL BORING IDs SG-1. SG 2, SG-3, SG-4�GROUT SPECIFICATIONS See Comments below S a-5, and Ga-6 DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of inches to depth of feet WELL IDs ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS []HOSE ❑PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: The borehole will consist of 1-ft of sand at the base, followed by 1-ft of dry bentonite, 1-ft of hydrated bentonite, 1-ft of sand, a granulated bentonite plug top of the sand, and grouting (cement) will fill the borehole until the surface. 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 AECOM Technical Services, Inc ._ Print Name Shapoor Hamid Date 9/18/2025 DEPARTMENT USE ONLY Application Accepted By: Date Issued: I Grout Inspection By/Dates: \ (1U�(� Destruction Inspection By/Dates: Facilit /Site Information FA Name FA Address — FA# PR# FA PE WP Reviewed By Work Plan Date ❑C-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Workers Comp giver [:]Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR r 7MMENTcrr'DNDITIONS: , YI I�"i l 0a y O l U f lt->fj 5 L UlV t t (J'lY"� L6iA�uw" y tA l'�' �—►LAW" l�hL�, Ill T�Z�' �'��(''►��,�lL FLc: f� b(l�A `CNtiI WP TYPE PE SC FEE INOO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit �D S 'Si $179 x ✓� �� n W P a5 0 11-7 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209468-34201 F 209464-0138 1 www.sjcehd.com EHD29-01 07-01-2025 'tw[i Site Mitigation Well Permit Application wt�( ID hq(W Gl "t,