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2 - z SANAOAQUIN a � '° ��° � Environmental Health Department ►�� ; `' COUNTY Greatness grows hers. 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 400 East Main Street City/State/Zip Stockton, CA 95202 Phone 209-598-3211 Cross Street South Sutter Street APN APN 149-15-024 Property Owner* Chris Neilson, Court Appointed Receiver Phone 209-598-3211 Address 400 East Main Street, Suite 740 City/State/Zip Stockton, CA 95202 66i24 ( " C-57 Contractor Malcolm Drilling Inc. License# 259543 n , - Phone 415-901-4400 Address 92 Natoma Street City/State/Zip San Franciscoi, CA 94105 Consultant/Sub-Contractor Geo Blue Consulting, Inc. License# Phone 415-755-3200 Address 35 Miller Avenue, #216 City/State/Zip Mill Valley, CA 94941 CONSTRUCTION WORK TO BE PERFORMED:*Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING M HOLLOW STEM BORING DEPTH 20.5'/23'bqf* ❑BOLTED TRAFFIC BOX STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE 2.5 to 4"/10" ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS Sch.40 TYPE OF CASING: ❑STEELXXVC ❑ OTHER ❑ SOIL BORING [N PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yes N No Boring Dia: Casing Dia: Casing Depth: .�❑y INJECTION(Air Soarae.Ozone) [I HAND AUGER GROUT SEAL DEPTH 5j" TREMIE TYPE TO BE USED: N AUGERS [I HOSE [I PIPE ,UOTHER piezometers/test wells 9/20 ❑ OTHER: GROUT SEAL PUMPED? ❑Yes N No (Note:Maximum Freefall Depth is 30 Ft) WELUSOIL BORING IDs MW-P2-1 to MW-P2-9;TW-1 to TW-20 GROUT SPECIFICATIONS 4"of concrete to match garage floor,overlying 1"of bentonite *bgf=below garage floor-wells to be installed In garage floor,at approx.elevation o - . ms,with ottom of casings at approx.- ms - ms 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:Nine(9) 1.25"-diameter groundwater monitoring wells to be installed in garage floor by 3.75"dual tube direct push methods to be completed with casing to extend 33"above garage floor within stove piped risers;Twenty(20)4"-diameter test wells to be installed in garage floor using 10.25" HSAs,to be completed with casing extending 18"above garage floor within stove piped risers. I hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Jnamiin County Ordinance Codes and Standards,and all other applicable California laws. Signed John Morgan o a 2024051416 01 28-07 Title/Company Vice President, Malcolm Drilling Company, Inc. Print Name John Morgan Date 5/13/2024 DEPARTMENT USE ONLY Application Accepted By: Gt� Date Issued: /22 ol Grout Inspection By/Dates: Destruction Inspection By/Dates: Facilit /Site Information �� FA Address J FA# 7 PR# i � F lwtn t'�i:Wn'��r�1�'l,�kcr�-n� � �- � i� FA Name Z� �-3 05 531 FA PE 1 2 WP Reviewed By VV Work Plan Date 2 Iff" )A AC-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver []Encroachment Permit []Access Agreement El Lead Agency Approval' MFR COMMENTS/CONDITIONS:All l 1�11 5 W— t�,e 7 r� 1%U'-%� KJhcv, wle , a.r)L 3; � ; � d� D�— �/1. f�Nc #,'t�vt w days WP TYPE PIE SC .'EE INFO AMT RE��M7IIT�TED CHECK# RECV'D BY DATE WELL[P�E,.RRMIIT# INvuiGE# Permit 129 J 0 1 t L- x !I y ZJ LC- J 1'v 1T 44 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 www.sjcehd.com EHD 29-01 04-20-23 Site Mitigation Well Permit Application