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oP°uiN c SA Nsd0AQ U I N Environmental Health Department Imo ' COUNTY �gcrPi' Greatness grows 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 1904 West Charter Way City/State/Zip Stockton/CA/95206 Phone (925) 278-8688 Cross Street Tillie Lewis Drive APN 163-020-41 Property Owner*Glenn Springs Holdings, Inc. Phone (713) 552-8765 Address 5 Greenway Plaza, Suite 110 City/State/Zip Houston/TX/77046 C-57 Contractor PeneCore Drilling License# 906899 Phone (530) 661-3600 Address 220 N. East Street City/State/Zip Woodland/CA/95776 Consultant/Sub-Contractor Geosyntec Consultants, Inc. License# Phone (925) 278-8688 Address 1304 Treat Boulevard, Suite 208 City/State/Zip Walnut Creek/CA/94597 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS I)I MONITORING 2 (M HOLLOW STEM BORING DEPTH 26'and 28' ®BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporMater) ❑ HAMMERIDRIVEN DIA.OF BOREHOLE 10' ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOILVAPOR PROBE ❑ MUD ROTARY CASING THICKNESS f U eM TYPE OF CASING: ❑STEEL ®PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Airsoaroe.ozone) ❑ HAND AUGER GROUT SEAL DEPTH 6'bgs and 8'bgs TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE IM PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes Od No (Note:Maximum Freefall Depth is 30 Ft) WELU SOIL BORING IDs MW-5CandMW-7C GROUT SPECIFICATIONS Bentonite and Neat Cement Mndure 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: I 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 j//� ''�/1�, Title/Company Project Director, Geosyntec Consultants Print Name Ron Gestler Date August 11, 2025 DEPARTMENT USE ONLY Application Accepted By: ,�--� Date Issued: Grout Inspection By/Dates: M.)N (, Destruction Inspection By/Dates: Facility/Site Information FA Name �� FA Address GF f FA# �rp� G! �¢� PR# 1 0 )�L FA PE (� WP Reviewed By Work Plan Date - ❑C-57 ❑G57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR COMMENTS/CONDITIONS: WP TYPE PE Sc FEE INFO AMT REMITTED CHECK# RECV'D BY DATE r 1,WELL PERRMIT# �1 INVOICE# Permit 261b , "Sl3 $179x �J C-L t2 Zs� W1 ZSW ��J 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-342 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 07-01-2025 Ze�u U4 J Site Mitigation Well Permit Application r