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Dr. Well, Water Well Svs. <br />916 962-7381 p.1 <br />SAN JOAQUIN COUNTY SHERIFF -CORONER <br />7000 MICHAEL CANLIS BLVD <br />FRENCH CAMP CA 95231 <br />209-468-4400 <br />EXPLOSIVES APPLICATION & PERMIT Less than 100 lbs S150)< <br />More than 100 lbs $250_ <br />PERMIT NUMBER f Ot P��ER��M......IT DATE 0�(���i /i) EXPIRATION DATE 04 q i <br />COMPANY NAME l Sc-'r\AC�b, tlrf. PHONE NUMBER <br />ADDRESS 40yJ S.� 1�i ��\ V G t� ��C 1� �1'Yi �t'l�U_ C� <br />AUTHRORIZED REPRESENTATIVEE-MAIL <br />BLASTER'i:i1-Q�� DL# CU?�Q-IL�:'��' STATE <br />��LICENSE# c�C� <br />BLASTER DL# STATE LICENSE# <br />BLASTER DL# STATE LICENSE# <br />VEHICLE LICENSE Ref to EOD file STATE MAKE MODEL <br />VEHICLE LICENSEE L�`� STATECA!�_ MAKE ���� MODEL <br />VEHICLE LICENSE STATE MAKE MODEL <br />TYPE OF EXPLOSIVE _�,<-_w Co' —G 4l. sa - , QUANTITY lbs <br />STORAGE `NO STORAGE IN SAN JOAQUIN COUNTY*" <br />SAFE TRANSPORT ROUTE <br />HOW/WHERE USED Various well sites within San Joaquin County <br />Unused explosives must be returned to the source, destroyed, or turned over to the permit issuing authority. (12108 <br />HS) r� <br />APPLICANT SIGNATURE PRINTED NAME �Cm.,.? C� JL <br />ATF CHECK DATE G'-1 114 11 % CA LICENSE CHECK DATE C)q h© Y <br />ADDITIONAL CONDITIONSIRESTRICTIONS Limited to well service work with NO storage authorized in San <br />Joaquin Cou <br />ISSUING AUTHORITTY San Joaquin C <br />NAMEITITLE _ L i . <br />ORIGINAL TO PERMITEE <br />COPY TO EOD FILE <br />Sheriffs Office <br />T <br />12103 HS <br />