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F paurN-ca S A N J O A Q U I N Environmental Health Department 1- 10 ` COUNTY— Greatness qrows 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 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 Soaree.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) 26'atMW-6B and 26'atMW-7B #WELLS TO BE DESTROYED Two Rl OVER-BORE DIAMETER of 10' inches to depth of feet WELL IDs MW-513 and MW-713 ❑PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Bentonite and Neat Cement Mbftre ❑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 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: �w Destruction Inspection By/Dates: Facility/Site Information FA Name . v� 4-r�`1G(Al FA Address C u r ,t f FA# 1 y D It PR# U 5 4 FA PE 2[�b J WP Reviewed By Work Plan Date 19G-57.._ -57 Authorization for Other to Sign Permit [! YWorkers Comp ❑Workers Comp Waiver ❑Encroachment Permit ❑Access Agreement '�'ead Agency Approval ERMFR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit tA V Z 3 $179 x 3 5'g 190 1 25(D 1 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 07-01-2025 2 p.0 1,-('D A 3' pp Site Mitigation Well Permit Application