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�2 u'" SAN J0A0UIN p 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 2401 N.MacArthur Drive City/State/Zip Tracy,CA 95376 Phone (209)8334254 Cross Street East Grant Line APN 213-070-500-000 Property Owner* Lephno Foods Comaopany Phone (209)8334254 Address 2401 N.MacArthur Drive City/State/Zip Tracy,CA 95376 C-57 Contractor Confluence Technical Services License# 1035255 Phone 707-639-7709 Address 800 M Street City/State/Zip Rio Linda,CA 95673 ConsultantlSub-Contractor GHD Services,Inc. License# Phone 279-977-1383 Address 201 Creekside Ridge Court,Suite 100 City/State/Zip Roseville,CA 95678 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 5.5 10 BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 3.5 ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ® SOIL VAPOR PROBE 3 ❑ MUD ROTARY CASING THICKNESS 0.25" TYPE OF CASING: ❑STEEL ❑PVC ® OTHER tenon tubing ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: 3.25 Casing Dia: 0.25" Casing Depth: 5.0' ❑ INJECTION(Air Soaoe.ozone) ® HAND AUGER GROUT SEAL DEPTH a6 Lt•v` 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 SV-1.SV-2.SV-3 GROUT SPECIFICATIONS Temporary vapor probe-hydrated bentonite up to 0.5'then concrete for the well vault 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 COMMENTS: Temporary soil vapor probes,constructed such that the middle of the probe is at 5.0'below ground surface,constructed with 0.25"OD teflon to 1 foot thick sand pack,0.5'of dry bentonite above that,then hydrated bentonite emplaced in 6"lifts up to 0.5'bgs,then well vault set in concrete at I hereby certify that I am authorized to complete this application and that the work will be done in accordance with 1 V �/ San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. 2 Q w�I� C Signed �a-'Pt�.l: Title/Company Geologist-GHD SAN✓O U Print Name Daniel Correia Date 05rov202s _ DEPARTMENT USE ONLY 4 Application Accepted By: �� Date Issued: ? >L' L L r Grout Inspection By/Dates: Destruction Inspection By/Dates: Facili /Site Information FA Name FA Address FA# PR# FA PE WP Reviewed By Work Plan Date l Z ❑C-57 Q G57 Authorization for Other to Sign Permit favorker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement lead Agency Approval ®-MFR COMMENTS/CONDITIONS: - L-j r'j I� Un c �,�Y G�i L-mot (— �>��,),: WP TYPE PE SC FEE INFO AMT REMITTED CHECK#I RECV-D BYr DATE I r(�(WELL PERMIT# INVOICE# Permit ;,7, $179 x V 1 t :) `5 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-342 F 209 464-0138 1 www.sjcehd.com EHD 29-01 07-01-2025 Site Mitigation Well Permit Application