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SAN JOAQUIN Environmental Health Department —COUNTY 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 950 Stewart Road city/StatelZip Lathrop, CA 95330 Phone 209-941-7430 Cross Street About 2,400 feet east of Somerston Pkwv and Stewart Road APN 21021001 Property Owner" City of Lathrop (Property was deeded to City in September 2022) Phone 209-941-7430 Address 390 Towne Centre Drive City/StatelZip Lathrop, CA 95330 C-57 Contractor Bradley and Sons Drilling and Pump Systems License# 414178 Phone 559-441-1401 Address 3625 S. Highland Aveunue City/State/Zip Del Rey, CA 93616 Consultant/Sub-Contractor Luhdorff&Scalmanini. Consulting Engineers License# HIS Phone 530-661-0109 Address 500 First Street City/State/Zip Woodland, CA 95695 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsile BoringsiWells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS [D MONITORING 2 ❑ HOLLOWSTEM BORING DEPTH 1,250 feet ❑BOLTED TRAFFIC BOX ®STOVEPIPE ❑ EXTRACTION(VapurWater) 0 RAMMERDPJVEN DIA.OF BOREHOLE 12.25 inches fill MULTIPLE CASINGS❑MULTI-LEVELWELL CASING DIA 2.5 inches ❑ SOILVAPORPROBE ❑ MUD ROTARY CASING THICKNESS Schad8WF4&1d-88A TYPE OF CASING: ❑STEEL OPVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yes ®No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(AV Smae.ozone) ❑ HANDAUGER GROUTSEALDEPTH 150kWl TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ®PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? 51 Yes ❑No (Note:M )imum Freeial Depth is 30 Ft) WELU SOIL BORING IDS GROUT SPECIFICATIONS "tl� ��3 -md.79aLLva>ter from 15tt to surface Intermediate Seal SshallagAteonilegroutwmprised of QUIK�GROUT rmanmsrAurespedgcaffons beNo xD DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THATAPPL-V1� p kin #WELLS TO BE DESTROYED me ❑OVER-BORE DIAMETER of_inches to depth of feet WELL IDS ❑PRESSUREGROUT To depth of_feet below surface GROUT SPECIFICATIONS [I 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: Test well is to remain longer than 30 days to allow for long term monitodnP of ASR operation(s.. I, / - /fur kr� v( t('e �ioh P•tht s $ N( V Ot$ ID:i'C �4W- h91 tjtve r F Y�7r S1 I hereby certify that I am authorized to complete this application and that the work will be done In accordance with Cd Be aquln„Counly Ordinance Codes and Standards,and all other applicable California laws. v Signed Title/Company Project Hydrogeologist, LSCE G Print Name Andrew Franci• Date 6/2 112 0 2 3 D TMENT USE ONLY Application Accepted By: Date Issued: W Grout Inspection By/Dales: yL Destruction Inspection By/Dates: Facilit /Site Information FA Name /p 0 r FAAddress I q43-0Wq W I FA# PR# 0 5 FA PE S� WP Reviewed By Work Plan Date /11 ❑C57 ❑C-57AUtdonIonRrOtherto Sign Pemlg ❑WakefsComp ❑Workers Carp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR em COMMENTS/CONDITIONS: /r61�) 7 L•S C G .Qr a l 1 20 L-.i: �Eto -ntrC(`crr jktuy 5,+e �u LW ;-e&k-C f rN ot-6 O-e r> b4*' s� bmhd It -Z7 s�w4'"�`i rl �/ -�rS�c 1 WC ( oJfa v 'hiodl WQ top o WP TYPE PE SC FEE INFO AMT REmiTTED1 CHECK# I RECV-DBY,I DATE W LL PERMI # INVOICE# Permit Z90 31 X t2� CG 3' f i z ��00�� 1868 E. Hazelton Avenue I Stockton, California 95205(Ib 02 9 6�8-3420 1 F 209 464-0138 1 wA s Ce .c�k�d EHD29-0104-20-23 L- ... n., ./. /L • .. �. ll L, � fY/ Sit M-tifi on Well Pe. Appiiwdor QC4,� �l V ,r"`+u'C ^�raL1•c A "l IA rllrLw• ✓- ZN{l.^ V'cL