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�61 � "N NS': II 6 l 0 Ur auiil paAIaaa� <br /> MELUPURUP PERMIT <br /> S r:N JnuCUTt CaUh'7Y&NRON PIRMAL HFaL7n Drpa"AENT 7866 E rSTHAZP-TCN AvIISl1E-STC--K DN CA 93VI5-(209)46&3420 <br /> TON REFuuDAs1E PERMIT CALL(209)9S3-7S97 FOP,IN ipEGTSONS EXPIRES 4 YEAR F:Rmi DnTE lssu_=a_ <br /> I.fasaen 1 3585 Copperopolis Rd _ _ C, m St�kton 9521 5 <br /> Cposss.. S JaCkTOile RdAPN � �� PaRa3srg �tawweAPaJcnTtcl <br /> r.7rr'rNE ]VAME Nelly Stallworth 209-943-6486 m <br /> GV,N A90ROM 135$5 Copperopolis Rd -�,���,- Stockton CA 9-5215 <br /> CQ1JT7?AC1oR Purviance Drillers, 1-ac 2n9-887-3554 <br /> Co:7TRACMR ADl)7iS5 PO Box b4 CMJS`M7Z7.CPL i n d e n, CA 95236 <br /> ISSJ BCQW,—RACTIIR FHOL <br /> SUB EGWRACfDR ADDRESS Ci r1Y1STA-r-Z1P <br /> L1cFt:sE 4 C-57 0�� :3 D-108 D Ota Nmiagi3 7!112 3 QfFlRATIDN DAr 7/31 f 19 <br /> Oo=:Es7S tt1.r;,L Saar mtr�Genr�al MinerUCoGiorm aacietia(4397)=GwrQlltochfnropraF�te(�i392)=Arsenic(4343) <br /> INTe.v©Use 0-amsraT6a(e C lninalianiAgricvltural G In&Mltrul G WaferQuaLtyplOrolcriag ❑Sail SampGnvrChara��tim <br /> F ubfir Water 5y3tem <br /> Ird:TcBMf'm Gtn= ttlnerS}�Marre ertcw 6'a yr Fnnn_Nrar¢c <br /> TYPE07Wawc CNeviWea C ReplEttNe:l [Wen AtleratlorN:SCEifiezlirnt Olhff <br /> C^MnitOrng WeI1(sZ ate els G SOU BOring(s) *a111". C GeoteMic2l =of1111 <br /> C cut-Of-semcn Wellut-Q Senrioe Welt Rcn�fat a Crassd awreLUOn F'Z2pafr <br /> C'110a Pump G FUnp Replacxre�c PLanp Repair,,(A V 4-yt 7 Raisaw—a `(�L•sinq <br /> l,vF.i Co,vsmarnav <br /> ;Drilling Method D thud RDtwy r Air ROt2ry 0 Auger O Cab12Ta01 7 Push Front 'C Other <br /> .IPmp=ed1Vef1 CePlh ft Etrauajc, ind2nmerer =Open2cftcrn [GrzmrPack/GravelS¢a indzareler <br /> ❑COrduelorCasing Tn drameler 1 Condu_nrCasing Depen R <br /> We(rising Dianeler_in TrrcknesslG-SWASTfd SChEv =S[Pd 0 Prastic C Slaudess SLeI :1 Mar <br /> Grou;SOai Depth is ] :1Send cement saCJ.r=7cA'.'la!Fr <br /> C Hentani a(ZO:b sa&ds) <br /> :10th <br /> Gro tPlnce nt:i8ethod 0 Purnpod O Frey'Fall 7 Other E RetardanElAcaleralor(name) <br /> PrMF-.=.- Installed By D OA(ev 3 Fu:np Gc'l1"dw O Other <br /> Lr Carcn�PeGesral CDimenslotts JfidBl R Length fIThick_in n CCrfsry aux- 7 Smve Pipe <br /> rFumP •Sa=em--h;e0 Tu rhine D 0lher Hp Pump Set R Standing WaiErtare: R <br /> I--.8y C'RI1rY THAT 1 HAVE PREPARED THs APF'LiCA-ncN RND THAT THS VMRK tNll-L DONE ih ACCORI10.f!CE L"1[Tt:{SAN <br /> JOAQUIN COUNTY ORDINANCES.SCAT-' LAWS, AND RULES AND REGULA-n0hS_ I ALSO CEFMFY THAT 67Y REQUIRED LICELSE IS <br /> CURRU3T AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE HOARD AND THa.AT I AW 1N CO3MPLIANCE WITH ALL <br /> 'NORKERS COMPENSATIUN <br /> fl01N1�24, VAUGE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)153-7697(�iL�>av 7�orporate Secretary & ¢ q <br /> III I I ( ! i I I ! IE r <br /> I I I <br /> I A II I If I ( ell I ! ! ! I il ! IIII <br /> III it II i I I ! II111 ! III t <br /> I I I I II I fliilll Y'IZAIT <br /> I I I I I I I l i <br /> I I 1 1 I I I l i I 1 I 11 f l 1 17 IVEFI) <br /> if Il 1 II illlllll ! l I I i <br /> 262019 <br /> o urA�c <br /> I �gml ''rAUNTM <br /> REPARTMENT <br /> I I I I I I <br /> 1 4j II <br /> I I f I I I 11 <br /> ! I E f I <br /> A'TMEV' <br /> RT U E Q L <br /> r �7 <br /> APP421idnAtcepted By ArnaRIOYeelp2 <br /> 4 <br /> Gmw Iruperm ay Date ' MQA I t Permit, <br /> pomp Inspetlon BY I �P� ��"� > k�D�� l � ❑ Waw Received <br /> Soo Baring ion ey Date COnuaUctietiVUell Depth ft <br /> COMMENTS (,A, <br /> PE SC Receivad Chacw Amount Dace Permill Inve'rcer _ iNell(E <br /> C04 , <br /> __ Info.._ _ h ._.... Remltled Servirc esY� <br /> 1 1,1LA VOU 111(i I <br /> IW-07 I <br /> I I I I I <br /> PGILT- <br /> b d out s.lalll.lQ aouelA.lnd e6�'.OL 6l tZ un(' <br />