Laserfiche WebLink
Cotmtywide Services Agency <br />Environniental Management Depattanent <br />Environmental Compliance Division <br />Elise Rothschild, Chief <br />County of Sacramento <br />Bradley J. Hudson, County Executive <br />Ann Edwards, Chlef Deputy County Executive <br />WELL DRILLER'S AUTHORIZATION LETTER <br />Val F. Slebal, Department Director <br />Site Address <br />2120 FRQ►-r fir I 5pc MA M EOV-TO, Cq q s 61 Ob <br />Well Driller <br />441-aFo2t-114 Pus•, 7e"-AVo A oG-ia -% <br />Driller's Address <br />V zo Ac,a boi.✓ <lveAxee -�4� L.e4,.jv2o, C� W5 <br />Driller's Phone No. <br />(-570) 357--S 7 7 <br />C-57 License No. <br />Oe) 1102- -7 <br />1Ex • Daae <br />09/2018 <br />For the sole purpose of procuring permits for the construction, modification, repair, or <br />destruction of wells or soil borings and the installation, repair, or replacement of well <br />pumps at the aforementioned site, I hereby designate the following entity(ies) to act as <br />my authorized representative: <br />Name(s) <br />h,& ) P -O <br />Com any <br />e- ,C.ay SQN A Wc-"Sco <br />Address <br />0,,g4MLc <br />City, State, Zip <br />.54,-' F ,t/GiscD j LA 95112 <br />I understand that as the applicant for permits for activities regulated under Chapter 6.28 <br />of the Sacramento County Code, I am responsible for compliance with all provisions of <br />that Chapter. I further understand that upon written notification to the EMD, I may <br />rescind this authorization. <br />Signature <br />h,& ) P -O <br />Printed <br />John D Rogie <br />Title: RMO, RME, Officer <br />RMO, President <br />10/13/2017 <br />Date: <br />&16!2012 Qlb W:Wetn1FORMSARCHVSWPIWELL5111 WELL DRILLERS AUTHORIZATION LETTER.DOO <br />10590 Armstrong Avenue, Suite A • Mather, California 95655 • phone (916) 875-8400 • fax (916) 875-8513 <br />