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SAN JOAQUIN Environmental Health Department <br /> —COUNTY <br /> Greatness 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 j <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 citylstate/Zip Lathrop, CA 95330 Phone (650) 292-9062 <br /> Cross Street McKinley Ave APN 198-040-31 <br /> Property owner* Scannell Properties 478, LLC Phone Not Known <br /> Address 3468 Mt. Diablo Blvd. Suite B-115 City/Stateizip Lafeyette, CA 94549 <br /> c-57 Contractor Confluence Technical Services, Inc. License# 1036255 Phone 707-639-7709 <br /> Address 6821 8th Street CKy/Statelzip Rio Linda, CA 95673 <br /> ConsultanUSub-Contractor EKI Environment & Water License# N/A Phone (660) 292-9100 <br /> Address 2001 Junipero Serra Blvd Ste 300 City/Statelzlp Daly City, CA 94014 <br /> CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BoringsANells Require Access Agreements or Encroachment Permits <br /> TYPE OFWELUBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTEDTRAFHCDOX ❑STOVE PIPE <br /> ❑ EXfRACTION(VapxWaler) ❑ HAMMERCRBIEN MA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING OIA <br /> ❑ SOILVAPORPROBE ❑ MUD ROTARY CASINGTHICKNESS TYPEOF CASING: ❑STEEL El PVC ❑ OTHER <br /> ❑ SOU-BORING ❑ PUSH POINT(GPI CPT) CONDUCTORGASING ❑Yes ❑No Boring Dla: Casbg Dia Cwrg DepUo <br /> ❑ INIECTIONWSo,.oimal ❑ HANDAUGER GROUTSEALDEPTH TREMIETYPETO BE USED: ❑AUGERS ❑HOSE ❑PIPE <br /> ❑ OTHER ❑ OTHER GROUT SEAL PUMPED? ❑Yes []NO (Note:Maximum Freefel Depth is 30 Ft) <br /> WEW SOIL BORING IDS GROUT SPECIFICATIONS <br /> DESTRUCTION WORK TO BE PERFORMED: 11 DESTRUCTION METHOD:(CHECK ALL THAT APPLY) <br /> #WELLS TO BE DESTROYED 1 evJSd ❑OVER-BORE DIAMETERof_Inches to depth of feet <br /> WELL IDs R 2 Q Ytr wtrt rfgl# ®PRESSURE GROUT Todepthof30 feet below surface <br /> GROUT SPECIFICATIONS Neat Cement -tMM7 2f/❑EXPLOSIVES Fran_to feel below surface <br /> TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE ®PIPE ®MUSHROOM CAP 03 feel below surface or feel below surface if>3 feet <br /> COMMENTS: <br /> Lat, Long: 37.82899, -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 Title/Company Project Engineer; EKI Environment&Water, Inc. <br /> Print Name Sam Cronin Date 06/14/2024 <br /> DEPARTMENT USE ONLY <br /> Application Accepted By: rr / <br /> Date Issued: � /( � 2 �� T <br /> Grout Inspection By/Dales: <br /> Destruction Inspection By/Dates: �Z <br /> acllll /Site I formaton <br /> p � IA nn <br /> FA Name U 'v) J1Tl FA Address o . Q lM FA# PR# <br /> FA PE WP Reviewed By I <br /> yj Work Plan Dale D <br /> ❑G-57 0G-57AUthodzaUmImOBlerto Sign Penelt ❑Workers Carp ❑Workers Compwelm ❑ErweactmenlRadt ❑Asosse Agreement []Lead AgemyApprovel ❑MFR <br /> COMMENTSICONDITIONS: p�'o��� G u — <br /> `.cp ire r� 4� c• Ki a..ir-e11 <br /> (ste July PiKtw,t c(tiuyv > d, CT F rC • <br /> IWPTYPEI PE I SC I FEEINFO AMTREMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# <br /> Permit $ �x q�cc 2 C - zl Z� w P2�-o 1311 <br /> 1868 E. Hazelton Avenue I Stockton;California 95205 1 T 209 468-34201 F 209 464-0138 Nvvv✓.sjcehd.cOhT <br /> E110 2941 04-20-23 She Miugeew Wei Pemtll Appltcaliw <br /> �Z <br />