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IS' A N1 JOHM 1 SITE R9 u OVATION WELL BOR MG GREG`W T APP L CATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hours Advance Notice Required For All Inspection : . CAI_ l _ ( ? n9 ) 953 •A7697 For INSPECTIONS Application is hereby made to San Joaquin County for a permit to construct and/or Install the work described . This applicotion is made in compliance with San Joaquin County Development Title, Chapter 9 -1115. 3, and the San Joaquin County Well Standards . Job Address 2050 East Freulunt Street _ City/StaterZlp Stockton , CA 95205 Phone 209 -467- 7676 Cross Street \ ui rh Lai ; rel Strect APN 153 - 130 - 030 Property Owner` t' i mont Plaza Investments LP ; DBA Freniont Plaza Storage Phone 209 - 467-7676 Address 2050 rest F% mont Street City/State/Zip Stockton, CA 95205 C-57 Contractor Slagle Drilling Corporation License# 1046151 Phone 1 - 916 - 363 -9355 Address ^ _ 11345 ':'rade Center Drive X450 City/State/Zip Rancho Cordova, CA 95742 Consultant/Sub - Contractor AdvancedGeo, Inc . License# 1063765 Phone 2094674006 Address 837 Shaw Road CItylState/Zip Stockton , CA 95215 CONSTRUCTION WORK TO BE PERFORMED : ` Note: Offsite BoringsMells Require Access Agreements or Encroachment Permits TYPE OF WELU13DRINGUN MBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑ BOLTED TRAFFIC BOX ❑ STOVE PIPE ❑ EXTRACTION (VaporMater) ❑ HA IMERIDRNEN DIA, OF BOREHOLE ❑ MULTIPLE CASINGS ❑ MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR 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 $Dame, Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑ AUGERS ❑ HOSE ❑ PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑ Yes ❑ No (Note: Ma)dmum Freafall Depth Is 30 FQ WELLI SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED : DESTRUCTION METHOD : (CHECK ALL THAT APPLY) 56 and 121 # WELLS TO BE DESTROYED 4 0 OVER-BORE DIAMETER of 8 Inches to depth of feet WELL IDs VEW-2 , MW44, IW-3 and EW - 1 ❑ PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS 94 lbs per 6 gallons El EXPLOSIVES X 1 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 : Well EW- I to be destroyed by explosives using contractor Tylor McMillin's Well Service , LLC; 916 -761 -5224; tinvwmellblaster. com; mcmillans521@gmad .com to j � j j ) � �i Mi Z. "r C' �� - c jt,Vl _ � ro � `Z ( 1hS. 7 b• l c` �� i —� h' 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/Corms pany -s GAA Print Name Daniel Villanueva Date DEPARTMENT USE ONLY Application Accepted By: JEFFREY WONG Date issued: 3 /2 /2022 Grout Inspection By/Dates : T 4 Destruction Inspection By/Dates ; Faclli /Site Information FAName APACHE PLASTICS FAAddress 2050 E FREMONT FA# FA0025903 I PR# FA PE 2960 WP Reviewed By JW Work Plan Date 12 / 16 /2021 13C-57 ❑ 657 Authorization for Other to Sign Permit ❑ Worker's Comp ❑ Worker's Comp Waiver ❑ Encroachment Permit ❑ Acceas Agreement C Lead Agency Approval MFR COMMENTS/CONDITIONS : WP TYPE PE Sc FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit 2902 313 $ 152x 4 608 C JW t2 / 25/ 202A WP0041613 confirmation # 139508396 � � tat3 ; 'j � ' I SO' 8 E . Hazelton AvdnUn I Stockton , California 95205 ( T 209 463 - 3420 1 F 209 464 - 013 �ww. sjgov . org /en' d EHD 29-01 06-28-21 Site Mitigation Well Permit Application