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f ANJOAQUIN p Environmental Health Department t •` I COUNTY 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 1810 E.Hazelton Avenue City/State/Zip Stockton,CA 95205 Phone (209)468-3000 Cross Street S.B Street APN 155-18-002 Property Owner* San Joaquin County General Service Department Phone (209)468-9598 Address 44 N.San Joaquin Street,Suite 590 City/State/Zlp Stockton,CA 95202 C-57 Contractor V&W Drilling, Inc. License# C57-720904 Phone (209)469-7700 Address 1133 Blackhurst Drive City/State/Zlp Galt,CA 95632 ConsultantlSub-Contractor Condor Earth License# Phone (209)234-0518 Address 188 Frank West Circle,Suite I City/State/Zip Stockton,CA 95206 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMER/DRIVEN DIA.OF BOREHOLE ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOIL VAPOR PROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER ❑ SOIL BORING ❑ PUSH POINT(GP/CPT) CONDUCTOR CASING ❑Yes ❑No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION(Air Soarge.Ozone) ❑ HAND AUGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: ❑AUGERS ❑HOSE ❑PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Depth is 30 Ft) WELL/SOIL BORING IDs GROUT SPECIFICATIONS DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED 22 total:10 monitoring,7 ozone,3 soil vapor,2 nested wells MOVER-BORE D IAMETER of 8 to 10 inches to depth of 6 to 60 feet WELL IDs MW-1 thru MW-10;OZ-1 thru OZ-7;SVP-1 thru SVP-3;SVE-1A/B/C;SVE-2B/AS-1 El PRESSURE GROUT To depth of feet below surface GROUT SPECIFICATIONS Type 1/11 Neat Cement ❑EXPLOSIVES From to feet below surface TREMIE TYPE TO BE USED ❑AUGERS [IHOSE ®PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: MW-1,MW-2,SVE-1A/B/C,SVE-2B/AS-1 will be overdrilled with 10"diameter augers to total depth(55 to 60'),MW-3 thru MW-10 and OZ-1 thru OZ-7 will be overdrilled with 8"diameter augers to total depth(44-56),and SVP-1 thru SVP-3(1/4"tubing in 2 1/4"borings)will be overdrilled with 8"diameter augers to total depth(6).Neat cement grout tremied through pipe from bottom to top in one pour,except SVPs,which will free fall to 6'into open borehole or through augers. 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 PG#6795/Condor Earth Print Name John P.Lane Date June 25,2024 DEPARTMENT USE ONLY Application Accepted By: Date Issued: Grout Inspection By/Dates: Destruction Inspection By/Dates: FacilitV/Site Information FA Name FA Address FA# PR# FA PE WP Reviewed By Work Plan Date ❑C-57 ❑C-57 Authorization for Other to Sign Permit ❑Worker's Comp ❑Worker's Comp Waiver ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval ❑MFR COMMENTS/CONDITIONS: WP TYPE PE SC FEE INFO AMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# Permit $162 x 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29-01 04-04-07 Site Mitigation Well Permit Application