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T� SKJOAQUIN p Environmental Health Department --COUNTY-- Greatness grows he e. SITE MITIGATION WELL & BORING PERMIT APPLICATION For Wells and Borings Used for Contaminant Investigations and Remediation NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 48 Hours Advance Notice Required For All 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 Navy Drive,Rough and Ready Island City/State/Zip Stockton,CA 95203 Phone (209)946-0246 Cross Street Humphreys Street APN 16203007 Property Owner* Port of Stockton Phone (209)946-0246 Address 2201 Washington Street City/State/Zip Stockton,CA 95203 C-57 Contractor Penecore Drilling,Inc. License# 906899 Phone (530)661-3600 Address 220 North East Street City/State/Zip Woodland,CA 95776 Consultant/Sub-Contractor Geosyntec Consultants,Inc. License# Phone (916)637-8048 Address 3043 Gold Canal Drive,Suite 100 City/StatelZip Rancho Cordova,CA 95670 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 25 ft bgs-80 ft bgs ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaponWater) ❑ HAMMERIDRIVEN DIA.OF BOREHOLE 2.25 in ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL❑PVC ❑ OTHER 10 SOIL BORING 24 PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yes❑No Bodng Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Spam,Gain) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS []HOSE ®PIPE ❑ OTHER ❑ OTHER GROUT SEAL PUMPED? ❑ Yes❑ No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDS GGW-1 through GGW-24 GROUT SPECIFICATIONS 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:Twenty-four borings will be advanced to collect grab groundwater samples at multiple depths with a maximum depth of 80 feet bgs.Borings will b backfilled in accordance with County specifications upon completing groundwater sampling. I here 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 Project Geologist Print Name Pete Dennehy Date 3/15/2019 Print N;� QEPAATMENT USE ONLY Application Accepted By / Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: Facili /Site Information G FA Name R`O� Qg� ' t FA Address Nu 1_. (� FA# 00 lS I bU PR# cs44g2- FA PE �i 610 WP Reviewed By r R L Work Plan ODate ❑C-57 2<57 Authomatbn for Other to Sign Permit IKorker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement OVead Agency Approval MFR COMMENTS/CONDITIONS: , WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV D BY DATE WELL PERMIT#J INVOICE# Permit 11,3 $152 x 3 0 L.i)i(, l l W 1 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 2M1 08.01-17 Site Mitigation Well Permit Application 301 G--X 3�u ( tcl 5(La0 ko- SS