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00D "N 060:: l Ml 'ZZ '130 aWll paAl ;�;� <br /> VVELLIPUMP PERMIT <br /> SAN JOAOUIN COUNTY E•WIRONMIDI AL HEALTH DIPARIMIEUT 1868 EAST HAZELTON AVENUE-STOcXwfj CA 95205-f209)469-3428 <br /> _ <br /> NON-REFUNDABLE�EFi1V(IT CAV2109�, 7697 FOR INSPECTIONS EXPIRES I YEAR FRom DATE IssuEt) <br /> JOBADDRESSQRO55 STnEErP�' AP ((�� P�wcEi Sfm LAND IISE APPLICATI ONZ Q g <br /> �' � PHONE <br /> OWNER NAME � <br /> OwNERADDREss ��''�(n�' 1�•1 �t rll ;t� ick,���i.��.. 2i;I Ci VISTA <br /> COVMAOroa Durviance 7)rillers , Inc PHar,>; 2n9-887-3554 1 <br /> CONTRACTOR AUURESS PO Box 64 CrWJSrATE17A?L i n d e n T -CA - 9 5 2 3 6 <br /> rSUOcv�4r.RAcrOR PHOME <br /> ESUla:SE <br /> BCO.vJRACTOR AWRESS CmiSTAC-57 u CC-6. -:1Die O Other NUMBER 377923 Expm-10N DATE 31 /1g <br /> Dar.1P.5TC 1fVE>-SANP1-!Nm=General Mineral(Coflform Bacteria(4391)E Oibramcchlaroprepane(4392)=Arsenic(4393) <br /> Itrrt7:DED USE ❑DomestidPrivate t Inigatfon/AgricuQoral C Industrial C Wa(eT QualAy fdorritvrin9 O Sail Samprrng/CharaCICrmtion <br /> C Pub,-;c WeleiStem <br /> If COrm PR1erS}'slrJn lane acrcrsc M1,tifr orPr,onx N¢m.MJ <br /> TYPE OF WO RK D Net.WO C Replacement Wel O 7 Other <br /> C!"10flitocfng VYafl(s) #01-wells C So,18aringM �cffwA"53 C Geotechnical =ol Dodngs <br /> ❑Out-Of-0ervice Wel' C Out-01-Serr'ce Well Renewal .3 Cras-Connec ion ReOair <br /> D New PUMD C pUrnp Replacement V Purnp Re alr 'r ,�, RalseVfell Cash <br /> LNELL I:ONSTRUCRON <br /> Dr[tlinghlothz)d O IAudRatay L AirP.olzry D Auger D Cable Tool 7 FusnParil r' ❑:her <br /> Proposed Well Depth l ExcavaGan in d�ameSer -Open cotton C Gravel PacWGravel Sae in diemeter <br /> 0CDnducmrCating in diameter / CcrducEorCasing Depth tt <br /> Well Casing Diameter_in TnicrnmeSsfGeu7JASTMSrhed -SteeJ :3 Fustic C Stainl2sSSJeel -3 Other <br /> Grout Seat Depth r3 D Neal Cement(94 to trag/540 gaf vrarer) D Sand Cement sacs:rnbd7 gPJuater <br /> D eentanile(20%sofas) D Other <br /> Grout PlacemeUtldlethod L•Pumped C Free Fall -:1 Other Relardant/Acederdlorlrlame) <br /> i P-TAL Installed By D DNler -3 Ptimp CDnractar ❑ Other <br /> ❑COncrere Pedestal CDtmeaMons-Wrdlh It LwNgthit i twx in -1ChristyBax LI SmVe PJpe II <br /> PULP iPSuixneisibleD Turbine 3 Other He 2,, Pomp Set 1_U ft StandingWaler Leve1_Ax ft <br /> 1 HERE6Y CERTIFY THAT I HAVE PREPARED TrilS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SATS <br /> .JOAQ❑NI COUNTY ORDINANCES, STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERT FY THAT r4Y REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT i Ata JN COMPLIANCE VYJTH ALL <br /> WORKEfrPENSATIOPJ <br /> MINI 241 F�ANCH NQTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)953-7697 <br /> T orporate SecgrE <br /> retar� <br /> I7777 <br /> i 1,7 <br /> � . <br /> SEN <br /> 1 II <br /> EoVE T <br /> i <br /> NCO <br /> ENTqNTM <br /> ! ! I RT <br /> MENT <br /> it I <br /> I IIikI II I <br /> A <br /> M E N T US flN Y(� <br /> APPW[ztidn Accepted By Date Area GnPla/ae 1D' <br /> Inspection y Date 7 PECIALWeII Permit <br /> Grout InsP Y <br /> Pump InWEL-ion By 1 D133 �I ���` DaSe Z ID UVAIVER ReeeiVell <br /> Sal Boring Inspection By Date CUnsvucled Wel(Depth tt <br /> COtMME14TS <br /> PE SC Received C ec Amount Peatllt Invoice# Well ID <br /> Co s. Irdo. - _ ..... .. h _. -_ emitted Dam- Service Re4uest>; - .I --- <br /> '9q09 74 2 2 I <br /> vr�trfutan P111 LUT <br /> ErID G7-L-j en,rc <br /> Z'd bZgU2860Z OUI saalll.lQ eoueiA.lnd e0t:01. 8L ZZ100 <br />