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SAN -JOAQUIN Environmental Health Department —COUNTY-- Greatness crows her, 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 501 S Ventura Ave City/State/Zip Stockton CA 95203 Phone 13046139635 Cross Street 1W.Hazelton Ave APN 145-080-002 Property Owner* I Daniel Munzer/Munco,Inc. Phone 5622831014 Address 3450 E Spring St,Suite 218 City/State/Zip Long Beach,CA 90806 C-57 Contractor Gre Drilling,LLC License# 1044456 Phone 9253135800 Address 12100 Goodyear Road City/State/Zip lBenicia,CA94510 Consultant/Sub-Contractor I Jacobs ILicense# INA Phone 3046139635 Address 2705 Bee Caves Rd City/State/Zip Austin,TX 78746 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH s n b s ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 14 in. I ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER H SOIL BORING 16 ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Saarae,ozone) HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: []AUGERS ❑HOSE q PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No ,(Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs GROUT SPECIFICATIONS iyZgA- L-(yyvbvt 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: I hereby certify that I am authorized to complete this application and that the work will be done in accordance with S Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed Title/Company Environmental Scientist/Jacobs Print Name Matt Loughney Date 1 5/15/2026 DEPARTMENT USE ONLY Application Accepted By: AA�,,� Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: 1 / Facilit /Site Information FA Name aC FA Address Z QZ��-o:' FA# PR# FA PE Z� (y 0WP Reviewed By L Work Plan Date O✓� ❑C-57 57 Authorization for Other to Sign Permit orker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit Access Agreement Lead Agency Xpproval MFR COMMENTS/CONDITIONS: WP TYPE PE Sc FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WEL/LPERMIT# INVOICE# 11 Permit �1 Tj t $179 x S�3 20835567 1 01/IrfPZG+01726 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 07-01-2025 Site Mitigation Well Permit Application