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pUlq <br /> SANJOAQUIN Environmental Health Department <br /> '" I •' �" —COUNTY— <br /> L. <br /> '-fit•.r.. i <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 <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 303 North El Dorado Street City/State/Zip Stockton Phone <br /> Cross street East Miner Street APN 139-080-03 <br /> Property Owner* Well Fargo Bank Phone 415 407-6905 <br /> Address 1755 Grant Street, 4th Floor City/State/Zip Concord <br /> C-57 Contractor Greg Drilling License# 104 445(o Phone 925-313-5800 <br /> Address 2100 Goodyear Rd City/State/Zip Benicia, CA 94510 <br /> Consultant/Sub-Contractor Klelnfelder License# Phone 916-366-2308 <br /> Address 3130 Kilgore Rd STE 200 City/State/zip Rancho Cordova, CA 95670 <br /> CONSTRUCTION WORK TO BE PERFORMED: *Note: Offsite Borings/Wells Require Access Agreements or Encroachment Permits <br /> TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS <br /> ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH --18 feet ❑BOLTED TRAFFIC BOX ❑STOVEPIPE <br /> ❑ EXTRACTION(Vapor'Water) ❑ HAMMERADRIVEN DIA.OF BOREHOLE 2-on ❑MULTIPLE CASINGS❑MULTI-LEVELWELL CASING DIA <br /> ❑ SOILVAPORPROBE MUD ROTARY CASING THICKNESS TYPE OF CASING: [I STEEL ❑PVC ❑ OTHER <br /> IA SOILBORING PUSH POINT(GP/CPT) CONDUCTOR CASING Yes RNo Bodng Dia: Casing Die: Casing Depth: <br /> ❑ INJECTION rAk6exaaezanel ❑ HANDAUGER GROUT SEAL DEPTH YD TREMIETYPETOB UUSED. [I AUGERS ❑HOSE ❑PIPt 1_ <br /> ❑ OTHER ❑ OTHER: GROUT SEAL PUMPED? ❑Yes ❑No (Note:Maximum Freefall Deph is 30 Ft) 3 .4/� <br /> WEWSOILBORINGIDs KLF-1 thru KLF-6 GRDUTSPECIEICATIONS 3 gallons per 47 pound of grout bott m to 4fieM s then <br /> 'v."V wC sand and rnld atrh asphalt -cr LT Me •.m.t�r: <br /> DESTRUCTION WORK TO BE PERFORMED: DESTRUCTION METHOD: (CHECK ALL THAT APPLY) • <br /> #WELLS TO BE DESTROYED ❑OVER-BORE DIAMETER of_inches to depth of_feet <br /> WELL IDs ❑PRESSURE GROUT To depth of feel below surface GROUT SPECIFICATIONS ❑EXPLOSIVES From to feet below surface '0 <br /> TREMIE TYPE TO BE USED [I AUGERS [I HOSE []PIPE ❑MUSHROOM CAP ❑3 feet belay surface or feet belay surface if>3 feet <br /> COMMENTS: Six direct push soil borings with soil and grab gw samples. rc< rCtrv,Ye„Y. kwel l4t4e5/��,wu <br /> yLl� � Lv.u(-44 0 <br /> 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 6 Title/Company Principal Kleinfelder <br /> Print Name James Helge Date 11/8/24 <br /> 1 � DEPARTMENT USE ONLY <br /> Application Accepted By: r/'\ Date Issued: Ill ' <br /> " �� �-� k <br /> Grout Inspection By/Dates:�JMA t t11221292Lt <br /> Destruction Inspection By/Dates: <br /> Facili /Site Information <br /> FA Name FAAddross FA# — PR# <br /> FA PE WP Reviewed By Work Plan Dale <br /> ❑C-57 ❑C-57Aut1orization for Other to Sign Permit ❑Workers Comp ❑Workers Comp Waiver ❑Encroachmeol Permit ❑Access Agreement ❑Lead Agency Approval ❑MER <br /> COMMENTS/CONDITIONS: SUiI (T��t`s� S,h,tal (u gra.���� i'o 3F-c-✓� h�'�. w( �� -�- wt' <br /> t•t� ulWrbaKc L W, ( rVyL 51Yt. LJtUSi«w��u4S r <br /> %v`vircn+vY wEw( S�SSv, c- = <br /> WP TYPE I PE SC I FEE INFO JAMT REMITTED CHECK# RECV'D BY DATE WELL PERMIT# INVOICE# <br /> Permit 2ao T -7j15 / w a-a4 � W Q 2Llot232?} <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 29-0106-01-2024 Site Mitigation Well Permit Application <br />