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ANJOAQUIN I f�°�eah a ,artnlent _ k COUNTY — —— _z:'1f{;;,Jrt;.°!-• _I F .tT t:ri�:i:i ��_ � I _ 'L'. SITE MITIGATION WELL & BORING PERMIT APPLICATION NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED 24 Hood's Advance Notice RegWr ad For A90 O specUons CALL (209) 963-7697 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 200 North Wilson Way City/State/zip Stockton, CA 95205 Phone NIA Cross Street East Channel Street and East Miner Avenue APN 15303029 Property Owner* Singh Propegy Inc. _Phone N/A Address 4751 Tudor Rose Glen Road City/StatelZip Stockton, CA 95202 C-57 Contractor Environmental Control Associates License# 695970 Phone (831) 662-8178 Address 3011 Twin Palms Drive City/State/zip Aptos, CA 95003 Consultant/Sub-Contractor AEI Consultants License# 654919 Phone (408) 442-2605 Address 2500 Camino Diablo city/statelzip Walnut Creek, CA 94597 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsNVells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 5 feet ❑BOLTED TRAFFIC BOX, ❑STOVE PIPE ❑ EXTRACTION(VaporMater) ❑ HAMMERIDRIVEN DIA,OF BOREHOLE 2.25 inches ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL.CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS N/A TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ® SOIL BORING ❑ PUSH POINT(GPI CPT) CONDUCTOR CASING ❑Yes ®No Boring Dla: Casing DIa: Casing Depth: ❑ INJECTION(Air 3pazme,Ozone) ❑ BAND AUGER GROUT SEAL DEPTH TREMIE TYPETO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER ig! OTHER Direct Push GROUT SEAL PUMPED? ❑Yes ®No (Note:Maximum Freefall Depth Is 30 Ft) WELUSOIL BORING IDs SB-.t and SB-2 (O".. ,)..pGROUTSPECIFICATIONS Neat cement grrout v� ra 1C`r 4 DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED NIA, C7 OVER-BORE DIAMETER of inches to depth of feet WELL lDs PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS ❑ EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS El HOSE ❑PIPE ❑ MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: = i :.........:;.. u t�rrze. _to nem fete= hts:a llrcatt n anrlabattthe:w rlc.wjI. nc .w.lt...:......::;:I lheeb certr.. ;that lm. ,#1 .. ...:.._..d_.:.............p. ..._. . _. ....p .._.. -._........:...-.. ..,-..:.:...._..._.:._.:..__... __...:_.. .-._..:.._-.._..:._..._ _.-... .... ..... ................. 5a' oquiln<County ir3r><i�nance;Oodes;atnd Standards;:and<aE!<ather.:ap:pl;0;31�.-*� toi niaivws Signed Title/Company Project Geologist/AEl Consultants Print Name Natasha Budimiroviic Date 317/2024 I _., DEPARTMENT USE ONLY Application Accepted By: y�.'� Date Issued: 1 Grout Inspection By/Dates: � 2zll Destruction Inspection By/Dates: ti Facilit /Slte Information FA Name ` ,"� '" FA Address F'A# PR# FA PE7 �® WP Reviewed By Work Plan Date . // C•57 G-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval MFR coMME�NTSi I ITIONS- $ �' r on � � A % r' C 10 7Ewr,1 Q - � (-� o� .� WP TYPE PE SC FEt INFO AMT REMITTED CHECK# R CV'D BY DATE WELL PERMIT#/ INVOICE# Permit ` o s Q $156 x I 1868 E. Hazelton Avenue I Stockton, California 95205 ) T 209 468-3420 1 E 209 464-01 SScCCr(; om END 20-01 04-20-23 Site Mitigation Well Permit Applicailon i 7 cr 1,