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SA610AQUIN a 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 compliance with San Joaquin County Development Title,Chapter 9-1115.3,and the San Joaquin County Well Standards. Job Address 23500 Kasson Road City/State/Zip Tracy,CA 95304 phone (916)255-3359 Cross Street Kasson Road APN 23912001 Property Owner* Deuel Vocational Institution(DVI) State of California Phone (916)255-3359 Address 9838 Old Placerville Road,Suite B City/State/Zip Sacramento,CA 95827 C-57 Contractor EnProbe Environmental Direct Push Drilling Services License# C-57 1012248 Expires 03/31/2026 Phone (530)693-0219 Address P.O.Box 6093 City/State/Zip Oroville,CA,95966 Consultant/Sub-Contractor AECOM TECHNICAL SERVICES INC License# Phone +1(916)216-6125 Address 2020 L Street Suite 300 Sacramento City/State/Zip CA 95818 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 3 ® HOLLOW STEM BORING DEPTH 35 feet ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMERIDRNEN DIA.OF BOREHOLE 8 inches ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS Schedule 40 TYPE OF CASING: ❑STEEL ®PVC ❑ OTHER IM SOIL BORING 3 ® PUSH POINT(GP/CPT) CONDUCTOR CASING IM Yes ❑No Boring Dia: 8 inches Casing Dia: 2 inches Casing Depth: ❑ INJECTION(Air Soarce.Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Ma mum Fyeef 11 D pth �t� WELLI SOIL BORING IDs Soil borings:SB-1,S&2,SB-3 GROUT SPECIFICATIONS Grout to surface M�� T Well:MW-1,MW-2,MW-3 5 feet of neat cement grout with 5%bentonite slurry 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 San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. Signed 47� Title/Company Project Manager/AECOM Print NameCBseV Sanders Date 11/1/2024 DEPARTMENT USE ONLY Application Accepted By: Date Issued: << l Ip l 2 Grout Inspection By/Dates: 7i a Destruction Inspection By/Dates: 15125- Notc, V kwl- /W Z-, ON L- 'a-45kj Facili /Site Information up S r UJ UJ Z � FA Namev � FA Address L' 54 S 'A &I r I FA# 1 00( PR# C> Z�W uZ FA PE I WP Reviewed By Work Plan Date 0L ❑C-57 ❑C-57 Authorization for Other to Sign Permit ❑Workers Comp ❑WAe Comp Waiver ❑Encroachment Permit []Access Agreement ❑Lead Agency Approval ❑MFR COMMENTSICONDITIONS: t;De 1; � Pu 3,L 3 -[<— (I ) i;vl.w (-To 64- & W i 5 W WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 7-C1P 7 $172 x 'yJ I l t' IN ` 1868 E. Hazelton Avenue I Stockton, Califomia 952051 T V9 468-3420 209 464-0138 1 www.sjcehd.com EHD 29-0108-01-202 4 1(�C,3L Site Mitigation Well Permit Application1.41