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SANdOAQUIN Environmental Floalth Dopaiiolinon-i COUNTY C>reulncs, glorvs live 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 94115.3, and the San Joaquin County Well Standards. Job Address 101 West Lathrop Road CltylStatnizip Lathrop, CA 95330 Phone N/A crossstreet Old Harlan Road APN 196-080-700-000 Propertyowner• Cardoza Family Trust (Edward Cardoza) Phone 209-531-6801 Address 2604 East Lovelace Road C)tylstalelZIP Manteca, CA 95336 C57Contractor ENCON Technologies License# 748576 Phone562-777-2200 Address 12145 Mora Drive, Ste . 7 CUy/StatelZlp Santa Fe Springs, CA 90670 Consultant/Sub-Contractor Partner Engineering s science, Inc. License# N/A Phone 774-414-3666 Address 490 43rd Street City/State/Zip Oakland, CA 94609 j CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite BodngslWells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH 15' (4) b 5' (5) ❑BOLTED TRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VapodWater) ❑ HAMMERDRNEN DIk OFBOREHOLE 211 ❑MULTIPLE CASINGS MULTI-LEVELWELL CASING DIA IQ SOILVAPORPROBE 5 ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: [I STEEL [I PVC ❑ OTHER 12 SOILBORING 4 IM PUSH POINT(GP/CPT) CONDUCTORCASNG ❑Yes []No Bodng Dla: GWISOOw: Casing Depth: ❑ INJECTION IAYSwraa Ozmel ❑ HAND AUGER GROUT SEALDEPTH TREMIETYPE TORE USED: ❑AUGERS []HOSE []PIPE ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:MaldmomFreelal Depth Is30Fit WELLISOIL BORING IDS R7—R1.0 and SGl—SG5 GROUTSPECIFICATIONs Neat cement grout via trenlnliep well/soil vapor probe sand pack will be removed before aroutincy DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) #WELLS TO BE DESTROYED [I OVER-BORE DIAMETER of^Inches to depth of feel WELL IDS ❑PRESSUREGROUT To depth of feel below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From_to_feelbebw surface THEME TYPE TO BE USED []AUGERS [I HOSE [I PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below 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 Joaquin County Ordinance Codes and Standards, and all other applicable California laws. Signed % Cli(:ejlas - Title/Company Project Manager/Partner PTInl Name Michel Helou Date 9/10/2024 .ARTMENT USE ONLY C� Application Accepted By: ' - Date Issued: GrouUnspeclion By/D es: I^ Destruction Inspection By/Dale . Facillt /Site Information FA Name 2516,5 Lam W FA Address 1101 W. m4Arbj�>jFA# PR# FA PE 57) WP Reviewed By Work Plan Dale C) WZ ❑C-57 ❑CL7Aalhodxa0onfw OlherloSgn Permit ❑WwkeesCow ❑Weds sOampWaiver ❑Encroachment Permit OAccessftoomanl ❑Load Agency Approval ❑MFR COMMENTSICONDITIONS: pl 10 Cc91f p'k , WP TYPE PE C I FEE INFO JAMT REMITTED CHE '# RECV'D BY DATE W L PERMIT# INVOICE# Permit _Zqo � 172X - ,I 2oZ VJ it 2�Fk I- , :> Z� 18(i8 E. Hazelton Avenue I Stockton, California 95205 i T 209 468-3420 i F 209 464-0138 i �w.sJce4i`d.com END 29 01 08-0i-NYL4 0 __ Site Mitigation Well Parma Approetbn I