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S A N . J O A O U IN Environmental Health Department —COUNTY Greatness grows here. SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Adviance 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 324 N. Hunter St City/State/Zip Stockton, CA 95202 Phone (209) 462-2900 Cross Street E. Miner St APN 139-140-17 Property Owner* Enterprise Car Rental Clry esP �oc F 4, i4o y,,A� (a-PV Phone same as above Address Same as above City/State/Zip Stockton, CA 95202 C-57 Contractor Middle Earth Geotesting License# 899451 Phone 714/633-5025 Address 23575 Chabot Blvd City/State/Zip Hayward, CA 94545 Consultant/Sub-Contractor FREY Environmental, Inc. License# 643673 Phone 831-464-1634 Address 1336 Brommer St. Ste. A6 City/State/Zip Santa Cruz, CA 95062 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 100 ❑ BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporMaler) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 2.5 ❑MULTIPLE CASINGS ❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS NA TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ® SOIL BORING 1 ® PUSH POINT(GP/CPT) CONDUCTOR CASING []Yes ®No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Soarge,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑ HOSE I2 PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? 2 Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs — ( — GROUT SPECIFICATIONS Neat Cement 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: 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 FREY Environmental, Inc. Print Name Terrence Inn Day ie;2022.10.31 t 9:25:21 -07'00' Date DEPARTMENT USE ONLY Application Accepted By: Date Issued: I `► �IS �j2 Grout Inspection By/Dates. \rvc Z Destruction Inspection By/Dates: Facilit /Site Information FA Name a14 ra FA Address I FA# 00 23q 69 1 PPA V G-4-( Apo FA PE WP Reviewed By ' Work Plan Date ❑C-57 C-57Authorzatbn for Olherto Sign Permit ❑Worker's Comp ❑ Worker's Comp Waiver '[EncroachmentPermit Access Agreement ❑Lead Agency Approval [jMFR COMMENTS/CONDITIONS: ('ice { `I o s' , _ rW L W d r �D %n5 nbNS� VPPi ht 4k#(�- ote'Stfr� ` �x W4 0-t- ALA i r i P4 -0). y (- e r W 1 nn P -h-en�+m;� ro K� +�� o�k7rV1 t and rn rakio GZt�?.t�' k le S�tbm o� r 's�11�5 +o WP TYPE PE SC FEE IN/ ^ AMT/REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2l V$ 5 l� f�G'�. 8 ! J �/ w �d '7 O8 2. s o0 8 o bq 1868 E. Hazelton Avenue I Stockton, f4orn 995205 2 9 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 04-04-07 156 C 1 _ (��n/t C' � / 57 �_ Site Mitigation Well Permit Application !06 og 2 R` YC I J`� zSL� $rjg� l