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ul/� i Oa SAN JOAQUIN Environmental Health Department � COUNTY COUum ------ ��,��,1�� ' Greatness grows here. 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 %2024- ( � C-57 Contractor Malcolm Drilling Inc. License# 259543 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 WELL/BORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING N 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: ❑STEEL)UPVC ❑ OTHER ❑ SOIL BORING PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes N No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air sparge,ozone) ❑ HAND AUGER GROUT SEAL DEPTH 511 TREMIE TYPE TO BE USED: D(I AUGERS ❑HOSE ❑PIPE (OTHER 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 insta e in garage loor, at approx. elevation o -5.5 ms , with ottom of casings at approx. -2 ms -28.5 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"-diareter 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 Jnanriin County Ordinance Codes and Standards, and all other applicable California laws. DigRally signed by John Morgan Signed John Morgan Data:2014.05.1416:0128-07'00' Title/Company Vice President, Malcolm Drilling Company, Inc. Print Name John Morgan Date 5/13/2024 DEPARTMENT USE ONLY - /2Application Accepted By: �� ' "� Date Issued: �.G Grout Inspection By/Dates: Destruction Inspection By/Dates: Facilit /Site Information FA Name �� ,r�1 �C�i��. FA Address r-C1(,i M f1 A FA# ��) �� ,�-� � PR# 0 FA PE � �f WP Reviewed By L Work Plan Date � i k �2 0 C-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval' MFR COM ENTS/CONDITIONS:�II �ti. l S �,t 2 > _ � AALAS-e— b� '�-tjZ*�y'C� I kiC4 1}� t 1�2 Y�r►'I+ w/ i.t1 f l a - n�' !cJ�c �— --� v1 -�-,'�ri w,=t'I� v d 'y s . WP TYPE No SC .:EE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# ttvvur�E# Permit (. o 1 3 II z '21)Z5 L-L�_. 1868 E. Hazelton Avenue I Stockton, Salifornla 95205 T 209 468-3420 1 F 209 464-013 wWW.sjcehd.com EHD 29-01 04-20-23 Site Mitigation Well Permit Application