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SAN J O A Q U I N Environmental Health Department CCNU NTY — .1 , ; r:�1,t'•`:' 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 COS ROW to 821 S Wilson Way (see attached map) City/State/Zip Stockton , CA 95205 Phone 209-937-8444 Cross Street E. Worth Street APN N/A Property Owner* City of Stockton Phone 209-937-8444 Address 425 North EI Dorado Street City/State/Zip Stockton, CA 95202 C-57 Contractor AdvancedGeo, Inc. License# 1063765 Phone 209467-1006 Address 837 Shaw Road City/State/Zip Stockton , CA 95215 Consultant/Sub-Contractor Slagle Drilling Corperation License# 1046151 Phone (916) 363-9355 Address 11345 Trade Center Drive City/State/Zip Rancho Cordova, CA 95742 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 ❑ BOLTED TRAFFIC BOX ❑ STOVE PIPE ❑ EXTRACTION (Vapor/Water) ❑ HAMMER/DRIVEN DIA. OF BOREHOLE ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA ❑ SOILVAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑ STEEL ❑ PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT (GP/ CPT) CONDUCTOR CASING ❑ Yes ❑ No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION (Air Sparge, Ozone) ❑ 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 GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED : DESTRUCTION METHOD : (CHECK ALL THAT APPLY) # WELLS TO BE DESTROYED Six (6) ® OVER-BORE DIAMETER of 8 inches to depth of 50-55 feet WELL IDS MW-3, MW-4, MW-7, MW-8, MW-9, MW-10 ❑ PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Portland type II cement to surface grade ❑ 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 : * EHD agrees to MW10 be destroyed by grouting in MW-7 through MW- 10 will be over drilled to 55 feet bsg with 8-inch hollow stem augers place to 17'bsg per 11 /17/21 AGI variant request based o MW-3 and MW-4 will be over drilled to 50 feet bsg with 8-inch hollow stem augers concern of overpass pier structural integrity , --JW 11 / 18/ 1 1 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 Staff Geologist , AdvancedGeo , Inc . Print Name Evan Schmidt Date August 3rd , 2021 iiiiiiiiiiiiiiiiiiiiiillillillillillillilliillillillillillillilliillillillilliillillillillillillilliillillillillI M - --- Illllllllllllll � WINE DEPARTMENT USE ONLY Application Accepted By: JEFFREY WONG Date Issued : 8/6/2021 (revised 11 / 18/2021 Grout Inspection By/Dates : r, `es2� variant approval , see Destruction Inspection By/Dates : above comments) Facilit /Site Information FA Name Former Ocampo Property FAAddress 821 S . Wilson FA# FA0023307 PR# PR0650773 FA PE 2960 WP Reviewed By JW Work Plan Date 8 /5 /2021 ❑ C-57 EXC-57 Authorization for Other to Sign Permit ❑ Worker's Comp ❑ Worker's Comp Waiver X Encroachment Permit ❑ Access Agreement ❑ Lead Agency Approval MFR COMM ENTS/CONDITIONS : This pen-nit is issued as an addendum to the original 7/ 19/2021 Work Plan and the new 8/5/2021 revised version of the Work Plan . Billable Party remains the same . WP TYPE PE SC I FEE INFO JAMT REMITTEDI CHECK# I RECV'D BY I DATE I WELL PERMIT# INVOICE# Permit 2902 313 1$ 152x 6 1 912 cc I JW 1 8 /3 /2021 1 WP0042325 confirmation number : 129496084 SR0083979 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www . sjgov. org/ehd EHD 29-0106-28-21 Site Mitigation Well Permit Application