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"; , SAN JOAQUIN Environmental Health Department I �.( I...`. `I COUNTY Greotness 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 Stewart Rd city/state/zip Lathrop, CA Phone (650) 292-9062 Cross Street Somerston Pkwy APN 210-040-02 Property Owner• Califia LLC - Susan Dellosso; Contact Ryan Alameda for access Ralameda0a cambaygroup.com Phone (209) 879-7900 Address own ;?3 W , -S-tiewav- & City/State2lp Notj�no6n Go.t�r.ra-��p 33a C-57 contractor Confluence Technical Services, Inc. License# 1035265 Phone 707-639-7709 Address 6821 8th Street City/State/zip Rio Linda, CA 95673 Consultant/sub-contractor EKI Environment & Water License# N/A Phone (650) 292-9100 Address 2001 Junipero Serra Blvd Ste 300 City/State/zip Daly City, CA 94014 CONSTRUCTION WORK TO BE PERFORMED:*Note: ORsile Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTEOTRAFFIC BOX ❑STOVE PIPE ❑ EXrRACTION(VaporMaho) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL MING DIA ❑ SOILVAPORPROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ❑ SOILBORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING Ell Yes ❑No Boling Dia: Casing Dia: Lazing Depth: ❑ INJECTION fasume.0zenel ❑ HANDAUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: [I AUGERS ❑HOSE [I PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Fq WEW SOIL BORING ID$ GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECKALL THAT APPLY) #WELLS TO BE DESTROYED 3 ❑OVER-BORE DIAMETER of—inches to depth of feet WELL IDs MWR-3, MWR-23, MWR-26 ®PRESSUREGROUT To depth of feel below surface GROUT SPECIFICATIONS Neat Cement [I EXPLOSIVES From to_feet below surface TREMIE TYPE TO BE USED ❑AUGERS []HOSE ®PIPE ®MUSHROOM CAP ®3 feel below sudace or feet below surface if>3 feel COMMENTS: Pressure Grout Depths (MWR-): 20' (3), 22' (23), 21.7' (26) Let, Long (MWR-): 37.7845, -121.3314 (3); 37.77917, -121.3341 (23); 37.78461, -121.3306 (26) I hereby certify that I am authorized to complete this application and that the work will be done in accordance with San Joaquin County Ordinance Codes and Standards, and all other applicable California laws. Signed Title/Company Project Engineer; EKI Environment & Water, Inc. Print Name Sam Cronin Date 06/14/2024 EPARTMENT USE ONLY Application Accepted By: ��- Date Issued: Grout Inspection By/Dales: .7 Destruction Inspection By/Dates: r - (� Facilit /Site Information FA Name FAAddress FA# PR# FA PE WP Reviewed By vJ Work Plan Date -:S-L4A ZD ❑G57 PiffVAuthotizadon for Othefto Sign Permit ❑Workers Comp ❑Workers Comp Waiver, ❑Ero7oachment Permit ❑Access Agreement ❑Lead AgencyAppreval ❑MFR COMMENTS/ ONDITION/S: VJZUDay&-; L •y $u'r� C7 r0`� OF-5 G— 0r W TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL P RMIT# INVOICE# Permit Q02 i $ X CC- 164 10,J Z Kq 010Q� 1868 E. Hazelton Avenue tockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 W ww BjG& i 6m EHD 29-01 04-20-23 Site Mitigation Well Permit Application I• '