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07/01/2008 14:33 9253130302 ' • 1 GREGG DRILLING HA6E 01 <br /> ueucon uonsultants @002/004. <br /> WELL DESTRUCTION PERMIT <br /> PURUC WATERSYSTEM❑Ym Z No <br /> SAM J6ApUM OouRTY ERvrnt»IwRNr+at.HdALYA Dt!pARTI1bRT ■ID lr MAIN STANNT-ST08,fToK CA 05785.(7c►)460400 <br /> NON-REFUNOA9LE PERMIT CALL(209J 963.7697 FOR IRSPECTIONS EXP) 93 7 YRAR FROM DATE IsQUE <br /> Jim Ab "Illi 0 y CIIynIP G �� d <br /> CROON 91REt' PN pRRCEL 3lrK_JIND Uaa A1PLICATeri of <br /> OuYrlO <br /> PS4- <br /> pHOxE <br /> 1sTATF2P3— <br /> CONTMSTUR ADDReas CITnBTAt#Itrp <br /> C-PWSIAPRLL{NC LICENNENUMPARII <br /> �1�'✓�/� fjpn{ATANOgTE '=jI '_J <br /> PE'RFORATIDN CoWMACTOR PNON■ — .71 <br /> PLRhORA"ft CONTRACTaR ADOREaa Cri'/fSTATa/.Tlr <br /> 17 C-Bv Wag DrIlIno Ltcanaa%Rabe► Cxplr■Ilan Gaip _ <br /> Bureau ofldeahot,rotiowo and Pleearrne.Ueom of Hlph 6xplDaivna Limnos r4-bef Explrollon Dole <br /> GNP Hazardoua Motorist TronepoAellan(or Rppmelvea Lloertee NumDe/ - _ tc7<plretloh pale <br /> Ban JaaBUlh CeuMy BheryR•Coroner BRpt■alvao Appllaarlam 0114 Parrnll Llcenas NUMpgr GNplmiron Date <br /> Li <br /> CpllEt>rTtle Occupational Safely Hhailh-Blaster vens Nurnbar E.Vivollo,Det# <br /> RsAR2KooRDtayftcTSM ❑ Dfy RePlrttamenr rtl q C■ m Q PII well ❑ InAolNe ❑ TCsi Hole <br /> DeleOtedl&uspeoladW►IlWdorCertmminene(r)—.Ta10 a >K <br /> AdJRCrnI propOfly Wllh cont■rnlhatloh(Aedreta) <br /> Known N05 f WelercoR(rmrnenv el■d!at:snl property r <br /> O Open Elanom G Gravel Porkeg D Urq■eea O Olhef <br /> WIN Lea cosy ebecllee Ypg-• Na Orout9M Q ?!o XT Yea 0( Iow ground uurfaeo(yp) 140I1.015maur eG Ibchar <br /> Wall Conductor CaaNq a Yee 9 No e.nlh of conduofar CeAIRp R bar OlRmrter of Condyelor Caalbg Inchea <br /> Wolf Cawing ONonsler_ _Indhes Total Depth Ztl -7 opthtowiv.yl f_- ayfYL tlopmorwalnoP�C.79 nbpe <br /> 89111n0 MEW191 From 1;0'f' R baa to :2-1c fl baa ROler MQ*MoI from R tips 10 It bop <br /> wall c■atng to be A162CM by one-of the fe0¢frhTO M ftfjl From A bps to b bop <br /> D Mills Knife _ Numborofcuteaverylandfpr <br /> 17 Eaploalvea❑ Ostohauntl Coro Q vOln proloellva every R fa wllltcul Pm1aetlla <br /> neu <br /> O Deleno e0ro and beoatefs 13 alt,p(6184..ovary _-_ A f7 whheut profeclle <br /> Q Otir11 <br /> SoaDnp Malerlal Nlzt COMOnt(pd fb pA/5 B pa ar „ Bend CamaAl aavM mlr f?pal wplor 0011911114 Pallolf <br /> BentOhlte(20 ao PClafar Spec ;p df,,,,�,_% Nam# Space at PPA Specs SUbmlIAB <br /> ea <br /> PlemontMolhad u a ProoFNI 01her <br /> Scot ConTpMnon Contpl010 wlh MUel+roam Cap 7.r� fl boo C#mphte to LrR1aMn0 9urlaea Pad <br /> I KEIREIRY CRRTIPY THAT 114AW PREPARED THIS APPLICATION AND THAT THE WORK anl,L BE DON[IN PXGORDANCIE IMTH1 BAN <br /> JOAQUIN COUNTY OROINANC86. STATE LAWS,AND RUM ANG RKOUIJITIONO. I ALSO CERTIPY THAT MY RRQUIRLM LICKNas (S <br /> CURRENT AND ACTIVE YTTI11 THE CALIFORNIA CONTRACTORS STATI!LICON&C BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br /> WQRKM COMPENSATIDN LaW8. <br /> 4 TICQ REQUIRED FOR INSPECTIONS Q/� <br /> CONTRACTORa 9rotIA7uKC TIT ? 0 <br /> C_o lbs`( 13 5 �t� ,-, • . . T <br /> L_ <br /> 06PAAyff%NT VON 0NN <br /> Appllotrosn Accepted By ._,...�._.+._.. Dau Arae , <br /> Deelrvetl■h Itlepoa(lon By Data Employae ION <br /> OOMMENT9 <br /> PERaeelwd rOW Amount bent RORNh/ IRYokeE► well An <br /> OodIMe a Cash AP ., Rome.al"umml <br /> D'Z 'L .tom <br /> 3503 z <br /> EMD a3 Oe Wru DEsTRUCneNPERMIT <br /> 1tNdh7 <br />