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• 4 ) z SA N J OAQ U I N Environmental Health Department COUNTY— ` Greatness crovvs her, 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 Rough and Ready Island City/State/Zip Stockton,CA 95203 Phone (209)946-0246 Cross Street Davis Avenue APN 16203007 Property Owner* Port of Stockton Phone (209)946-0246 Address 2201 West Washington Street City/State/Zip Stockton,CA 95203 C-57 Contractor PeneCore Drilling License# 906899 Phone (530)661-3600 Address 220 N East St City/State/Zip Woodland,CA 95776 Consultant/Sub-Contractor Geosyntec Consultants Inc. License# Phone (510)836-3034 Address 1111 Broadway Street City/State/Zip Oakland,CA 94607 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 6 It ®BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE a inches ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ® SOIL VAPOR PROBE 11 ❑ MUD ROTARY CASING THICKNESS 1/4" TYPE OF CASING:❑STEEL ❑PVC ® OTHER -^'sss ter«o.mower la SOIL BORING 5 ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes [Z No Boring Casing Dia: Casing Depth: ❑ INJECTION(Air Sparse,Ozone) ❑ HAND AUGER GROUT SEAL DEPTH >j�j r ♦ TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE PIPE ❑ OTHER ® OTHER: Direct Push GROUT SEAL PUMPED? ❑Yjs No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING Os 817E-08.817B-09.8176-10.a176-11.FR-12. GROUT SPECIFICATIONS 3 gal of water to one 47-lb bag of portland cement 8176-13,8178-14,817B-15,817B-16,817E-17, 817E-11 17B-19.8176-20,8178-21,817B-22, 8176-23 DESTRUCTION WORK TO BE PERFORMED: D RUCTION METHOD: CH ALL THAT APPLY #WELLS TO BE DESTROYED ❑OVER BORE DI ER of inches to de feet WELL IDs ❑PRESSURE GROUT o depth of feet b 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: Work plan outlines the soil borings at soil sample,grab groundwater,and soil vapor probe installation locations.The locations are co-located,and there will be a total of 16 borings.Soil vapor probes installed will be permanent. 5 V 1 t-u Q'VV" tV' - I hereby certify that I am authorized to complete thA.applicatiori 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 Geosyntec Consultants, Inc. Print Name M gan Carlson Date 2/17/2025 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: (0I Destruction Inspection By/Dates: Facilit /Site Information FA Name 1Z L �� FAAddress �,L FA# 0Q) I PR# FA PE (� C� WP Reviewed By Work Plan Date 121 - L W-57 C-57 Authorization for Other to Sign Permit I4Worker's Comp Worker' Comp Waiver ❑Encroachment Permit [:]Access Agreement ead Agency Approval 5"MFR COMMENTS/CONDITIONS: a ro j ,,� l rr►�. 5 rL ),,5 A I/ WP TYPE PE Sc FEE INFO AMT REMITTFO CHECK# RECV D B DATE WELL PERMIT# INVOICE# Permit cl C $172 x 0 .S 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 08-01-2024 1 q (• �ry)L Lt'5 "> Site Mitigation Well Permit Application