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"' SANJOAQUIN Environmental Health Department COUNTY cltrronae 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. Job Address 309 W.Yosemite Ave&105 Sycamore Ave City/State/Zip Manteca, CA,95336 Phone Cross Street Manteca Ave APN 217-210-100&217-210-110 Property Owner* City of Manteca Phone 209.456.8562 Address 1215 W. Center Street,Suite 201 City/State/Zip Manteca/CA195337 C-57 Contractor TEG-Northern California License# 706568 Phone 916-853-8010 Address 11350 Monier Park PI City/State/Zip Rancho Cor ova, CA, 95742 ConsultanUSub-Contractor Condor Earth, Luke Castle License# PG No. 9945 (Luke Castle) Phone 209.513.7634 Address 188 Frank West Circle, Suite I City/State/Zip Stockton, CA, 95206 CONSTRUCTION WORK TO BE PERFORMED:*Note: OUsite BodngsNVells Require Access Agreements or Encroachment Permits TYPE OF WELLIBORING NUMBER INSTALLATION TYPE CONSTRUCTION SPECIFICATIONS ❑ MONITORING ❑ HOLLOW STEM BORING DEPTH -15-20 ❑BOLTEDTRAFFIC BOX ❑STOVE PIPE ❑ EXTRACTION(VaporMater) ❑ HAMMERORIVEN DIA.OFBOREHOLE 2,25' ❑MULTIPLE CASINGS❑MULTI-LEVELWELL CASING DIA 13 SOILVAPORPROBE 3 ❑ MUD ROTARY CASING THICKNESS TYPE OF CASING: ❑STEEL ❑PVC ❑ OTHER © SOILBORING 3 ® PUSH POINT(GPICPT) CONDUCTORCASING [I Yes [I No Boring Dia: Casing Dia: Casing Depth: ❑ INJECTION fAFSperm.0,1 ❑ HANDAUGER GROUT SEAL DEPTH THEME TYPETO BE USED: ❑AUGERS [I HOSE [I PIPE ❑ OTHER ❑ OTHER: GROUTSEALPUMPED7 ❑Yes El No (Note:Madmum Freefall Dept is 30 FQ WELUSOIL BORING IDS ASG-lthmugh ASG-3 GROUT SPECIFICATIONS oe P pDP-i through DP-3 S Dt TRUCTION WORK B T E PERFORMED: 16 (CHECK DESTRUCTION METHOD: ALLTHATA PLY) 0 #WELLS TO BE DESTROYED El OVER-BORE DIAMETER of 2.25 inches to depth of -15-20 feet WELL IDS ❑PRESSUREGROUT To depth of feet below surface GROUT SPECIFICATIONS Type l and Type ll [1 EXPLOSIVES From to_feel below surface TREMIE TYPE TO BE USED ❑AUGERS ❑HOSE I]PIPE ❑MUSHROOM CAP ❑3 feet below surface or feet below surface if>3 feet COMMENTS: ASG-1 through ASG-3 to be temporary multi-completion soil gas wells screened at 5 and 15 feet bgs. DP-1 though DP-3 are direct push borings to obtain grab groundwater samples and soil samples, if warranted (see work plan) Wells to be destroyed pursuant to SJCEHD Well Standards I hereby certify that I am authorized to complete this application and that the work will be done in accordance with / �Sann Joa In County Ordinance Codes and Standards,and all other applicable California laws. Signed .L-L Title/Company PG No 9945, Condor Earth Print Name Luke Castle Date 411212024 DEPARTMENT USE ONLY Application Accepted By: V1 ONLY Date Issued: Grout Inspection By/Dales W- 11.5 I a�j— t'iQ../S c�.r el, �lj /r/ 5{ Z �,SG��' �j r�I�1.Cr,,,•S c,A,•,-/ Destruction Inspection By/Dates: Facilit /Site Informatfo FAName t) .Q ' yr- IYJi FA Address ( W. I FA# PR# jeoyy#?o FA PE Z O WP Reviewed Byoj Work Plan Date It 2 2O2 ❑C-57 C-57AutMdzaUonfo Oterto Sign Permit ❑Worker's Comp ❑Worker's Comp Waterer ❑Encroachment Permit ❑Access Agreement ❑Lead Agency Approval MFR COMMENTS/CONDITIONS: ,r/ feer Gu .L pt7m'• V P � 4M14 i t On "'ITteo to !K , 1 / VIP TYPE PE T SC FEE IN AN RENlrrTEDj CHECK# I RECV'D BY I DATE WELL PERMIT# INVOICE# DD Permit T D 313 1162 X 5 1 g l0 I CC_ I Id 6 /V wP g51r5+ I : 9 S 153 ---7- $.5 t SS('00g:7- 94- - 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com EHD 29M 7-01-2023 Site Mlegagon well Permit Application