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SAN JOAWN Environmental Health Department L COUNTY . •%. a Y Greatness 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. UJe s11;.tS Stockton, CA 95205 Phone Job Address 1050 S. Diamond St.(nEa.r s , L, - City/State/zip Cross street Dr. Martin Luther King Jr Blvd i �APN 155-320-230 Property owner Diamond Foods Phone Address 1050 S. Diamond St. city/state/zip Stockton, CA 95205 C-57 Contractor Cascade Drilling License# 1058336 Phone 916-638-1169 Address 3006 Duluth St. city/statelzip West Sacramento, CA 95691 COnsullant/SUb•COnfractorATC Group Services LLC dba Alias Technical License# Phone 209-579-2221 Address 1117 Lone Palm Ave., Suite 201 B City/State/zip Modesto, CA 95351 CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Bodngs/Wells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOWSTEM BORING DEPTH 36 ft. ❑BOLTEDTRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(Vapor/Water) ❑ HAMMERDRIVEN DIA.OF BOREHOLE 3 In_ ❑MULTIPLE CASINGS❑MULTI-LEVEL WELL CASING DIA ❑ SOILVAPORPROBE ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER 19 SOILBORING ® PUSH POINT(GPI CPT) CONDUCTORCASING ❑Yes ®No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION fAksmo,0zme1 ❑ HANDAIIGER GROUT SEAL DEPTH TREMIE TYPE TO BE USED: [I AUGERS [I HOSE MPIPE ❑ OTHER ER: GROUT SEAL PUMPED? ❑Yes ®No (Note:Maximum Freefell Depth is 30 Ell WELILSO1L BORING I —14 GROUTSPECIRCATIONS nt3At CpMent DESTRUCTION WORK TO BE PERFORI— ,. DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of feet WELL IDs ❑PRESSURE GROUT Todepth of feelbelowsudace GROUT SPECIFICATIONS [I EXPLOSIVES From to feel below surface TREMIE TYPE TO BE USED El AUGERS [I HOSE ❑PIPE El MUSHROOM CAP ❑3 feel below surface or feet belay surface if>3 feet COMMENTS: I hereby certify that I am authorized to complete this application and that the work will be done In accordance with � -San Jgaquln County Ordinance Codes and Standards, and all other applicable California laws. Signed lb�•',"�11— Title/Company Project Manager Print Name Matthew Tolbert Date 7/29/2024 DEPARTM NTU EONLY 2 Application Accepted By Date Issued: 7 �U Grout Inspection By/D s: Or Destruction Inspection By/Dates: Facilit /Site Information FA Name FA Address 6) 5O .Gt 41 FA# 9 2 PR# FA PE 2o\ 60 WP Reviewed By I Vj Work Plan Date ❑C-57 C57Authorizatien for Other to Sign Permit ❑Wakens Comp ❑Workefs Comp Waiver ❑Encroachment Permit ❑AccassAgroement ead Agency Approval FR COMMENTS/C NDITIONS: [ D wLA• COrt/ 0 I�efOfk- .� QP�hp t— we St- s WP TYPE PE SC l FEE INFO ,AAMT REMITTED CHECK# RECV-D BY DATE 1 — WELL PERMIT# INVOICE# Permit Z la 3K $1 2 3If 9 4 z uJ p Zv i Ig6 zu-�' sR 2t}oo 3g 2 1868 E. Hazelton Avenue l Stockton, California 95205 l T 209 468-3420 l F 209 464-0138 l www.sjcehd.com EHD 29-M 7-et-2023 Site Mitigation Well PermitApplication