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SAN 10AQUIN Environmental Health Department <br /> —COUNTY <br /> Greotness grows here. <br /> SITE MITIGATION WELL & BORING PERMIT APPLICATION <br /> NON-REFUNDABLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED <br /> 24 Hours Advance Notice Required For All Inspections <br /> CALL (209) 953-7697 For INSPECTIONS <br /> Application is hereby made to San Joaquin County for a permit to construct and/or Install the work described. <br /> This application Is made In compliance with San Joaquin County Development Title,Chapter 9-1115.3, and the San Joaquin County Well Standards. <br /> Job Address Lathrop Rd citylstatelzip Lathrop, CA 95330 Phone (650) 292-9062 <br /> Cross street McKinley Ave APN 198-040-29 <br /> Property owner' Scannell Properties 478, LLC Phone Not Known <br /> Address 3468 Mt. Diablo Blvd. Suite BA 15 citylstatelzip Lafayette, CA 94549 <br /> C-57 Contractor Confluence Technical Services, Inc. License# 1035255 Phone 707-639-7709 <br /> Address 6821 8th Street citylstatelzip Rio Linda, CA 95673 <br /> Consultant'Sub-Contractor EKI Environment & Water License# N/A Phone (650) 292-9100 <br /> Address 2001 Junipero Serra Blvd Ste 300 citylstatezip Daly City, CA 94014 <br /> CONSTRUCTION WORK TO BE PERFORMED: *Note: OHsite BoringsivVells Require Access Agroo,,,omo cn�rn��Hmo„r Pnrmils <br /> TYPE OF WELLIBORING NUMBBEE INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTEDTRAFFIC BOX ❑STOVEPIPE <br /> ❑ EXTRACTION(VamMater) ❑ HAMMERDRIVEN Da.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELLCASING DIA <br /> ❑ SOILVAPORPROBE ❑ MUD ROTARY CASINGTHICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER <br /> ❑ SOILBORING ❑ PUSH POINT(GP/CPT) CONDUCTORCASING ❑Yes ❑No Bedell Via: Casing Dix. Casing Depth: <br /> ❑ INJECTION(Aksmee.Ozanel ❑ HAND AUGER GROUT SEAL DEPTH TREMIETYPETO BE USED: ❑AUGERS ❑HOSE ❑PIPE <br /> ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Madmum Freels[Depth is 30 F9 <br /> WELL/SOIL BORING IDs GROUT SPECIFICATIONS <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) <br /> #WELLS TO BE DESTROYED 1 [I OVER-BORE DIAMETER of_Inches to depth or_feet <br /> WELL IDs RMW-2 OPRESSUREGROUT Todepthof 30 feetbelowsudace <br /> GROUT SPECIFICATIONS Neat Cement [I EXPLOSIVES From_to_feel belox surface <br /> TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ®PIPE ®MUSHROOM CAP ®3 feel below surface or teal belay surface if>3 feel <br /> COMMENTS: <br /> Lat, Long: 37.82499, -121.2692 <br /> 1 hereby certify that I am authorized to complete this application and that the work will be done In accordance with <br /> San Joaquin County Ordinance Codes and Standards,and all other applicable California laws. <br /> Signed TRie/Company Project Engineer; EKI Environment & Water, Inc. <br /> Print Name Sam Cronin Data 06/14/2024 <br /> DEPARTMENT USE ONLY Z <br /> Application Accepted By: Date Issued: <br /> Grout Inspection By/Dates: <br /> Destruction Inspection By/Dates: <br /> Facility/Site Information, <br /> FA Name I FA AddressJOIAl-&L— FA# - PR# i <br /> FA PE 5 WP Reviewed By Work Plan Date <br /> ❑G-57 57AU1hedzalIonWOIh&IDS1gn Pwmit ❑WOFWSCMP ❑Workers CompWalver ❑Enmachment Pemdl ssAgreemenl I4gad Agency Approval Q4FR <br /> COMMENTS/CONDITIONS:fSS� <br /> 7,t ,,#,b .-f— of— r'ov%- 14-1 CL4-Q - :Tw(y <br /> 'P t";( C ka;n) c4 2v v SeMr a win tt �JC GT- repo rc- <br /> WP TYPEI PE SC I FEEINFO 1AMTREMiTTED1 CHECK# I RECV'D BY DATE WELL PERMIT# I INVOICE# <br /> Permit 1:23C)y l $,156x S.0 g ZI Z WF246 $ _ <br /> 1868 E. Hazelton Avenue S ocktcn, California 9520 I T 209 468-3420 1 F 209 464-0138 1 www.s cehd.c&n r' <br /> EHD 29-0104-20-23 Site Ml4gaeon Wall Permit Application <br />