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96[5 "N W cu 6 0 tiZ 'U W I J paAla�a� <br /> !1l ELUIPUMP PERMIT <br /> Srer ionaLti >;oaurY'euv�oNamva LHeI LTH DEPAsersa4T 1868 EAs7HAzEi.-mN Ava9ur-S�TcexTon CASS205-I2G9)46T:220 <br /> LION-REFL DAME PmwT CALL 809 953-7697 FOR INSPECTONS EXPIRES i YEARFR=DATE lssuao <br /> m <br /> 10740JackTone Rd s.,,�tockton <br /> (JOS Alton="" - <br /> iCx'xs--In= Live Oak Rr' -AP <br /> I r-�ARGEL.ciIIE LrvrD USEAPPLtI'11Ta17� c <br /> VP -I_ ;�i r �LPHa�269-941 -4500 <br /> I OYRris't I�lAL1E -r�L—a 4:i V n roc _ <br /> (cvxrE*x AnDrr_,s P O B ox 1 7 0 crnjS-„Tvj i n d e n Ca 95236 <br /> �CavrRAcrrt Purviance Drillers , Inc PHo, 209-887-3554 <br /> �CO�JiZACtaR Amari <br /> PO Bag 64 jsT5a,�Linden, CA 95236 <br /> NN .ISela CON7itgC AOR fPHOhc <br /> SV3CD,VTRACMR ADDRESS L CrMSTATEMP <br /> uCr mrE V Csr n C-61 -:1 D-G9 n athEr NOUaER 377923 BoTgA;,cN DA,-,; 19 <br /> Ooct�^,meolE1LSr zn Lt-D r�C-eneial I,&nerauCollform 8actezia(4331)_D'nmmoc�[oreproPane(9392):Arsenic(4393) <br /> I lwr�ID UsE til 0amEsfrlPrivare G IrdgalionrAgriCv:til G lydMtrial G WaleTQuality mWolcring ❑Sol SampringrCharaderf�lion <br /> Public Water Sgntem <br /> l lrGTuent from A�'ocr_ tv�erSpzternn�ae Law=laic sP.-m Nmis <br /> TWFoFWCwc 7,Ner We[l C Rep[acemantWell C WeDPJteraliaNt1c-,Mmdon 7 Olhe; <br /> G SOD 60ring(S) ;;oTUrnW-1 s G Geo=Mlcal <br /> Qua-Of-Zenkn vVell ^GUI-C Service Wel]Rena�ra: 7 Crass-Cdnneclion ELC?ir <br /> t Noa Pump C F=p RCpL=meat %Pump Repair -2 R2_1sayyen Casing <br /> I WELL CnAomucmom 1 <br /> 1IM ing Metnnc D MUd Rotary G Air RatMY G Auger 7 Ca aTaoi 7 Push Paint D am <br /> Praposedmil Depth ft Eadvalim in diameter =Open 6oflam G Gravel Pain1Grauo2 Tcze in drrireler <br /> 13 ConduCDr Casing to trrxneler f Coi%dudnr Casng❑epih 11 <br /> I Well using G-I neer_in ThidrneLslGaugelASCiASc6ell =Steel 7 Pfzsftc n Staiaiess Slee] 7 01JEr <br /> GroufSeal Depth i, G Neat Ce rnalt(94 16 .1 rrabm G Send Cement Irl rnrsl7 g�lreta <br /> C Eentu nie(23%so Gds) -2 O then <br /> GroutP)acemeniri3elhnd Q Pumped 0 FreaFall -3 MET a RetudaltlA=AeratorOmue) <br /> PEED=TAL inNIOled By Cl DrZer G Pump CAnrr cr D ORler <br /> C!Concre:Peck-,WICDlmertsicfsWic'L'7 I; Langth 1f Thick in 1cMje;1Y8= 7StevePtpe <br /> Pnh�v *SubniersiWP-0Turbifw- 00th HP PwnPSul I ft St3nding%rJW.@r Lrere] - f1 <br /> 1 HEREBY CERTIFY THAT 1 HAVE FREPARED THIS APPUCAnoN AND THAT THE kVORK WILL 9E DOME IN ACGOR MICBi —AMffSAN <br /> JDACUIN COUNTY CR11rU=ES, STAT^c MWS, AND Rums AND RsouLAnonrs 1 ALSO CEFmr-Y THAT W RmLrRED LICENSE Is <br /> CURRENT AND ACTTVE ILVM THE CA1JFDi3MA C0MRACTCRS STATE LIC tT15 BOARD AND THAT I A6) IN COMPLIANCE WITH ALL <br /> `N{] NIPE1fSA71� LVS_ <br /> rgi <br /> U. <br /> VANCE NOTICE REQUIRED FOR f(tlSPECT10I1F5-PLEASE GALL(209)95 7697 <br /> T, TpOrate SecretaraAT=- /9 <br /> IIII lif I I f I t I I I I f IIlf <br /> I I II I I FV.FrjI <br /> III Id I II 1,V.T II fl I II I I I I <br /> III ! II I I I <br /> I I I I I 1 ( I I I o PA <br /> IV <br /> l ill I i I I IIII ! III ! i <br /> I I I I I J I I w,0 6 2019 <br /> I E I I I 1 I I I i ��(RO�UINCOO <br /> I I I I I I CTH ofi M�7 Nry <br /> I t I I ( I I I I I I l 11 I ! f ! I pq q� <br /> ( I I f l I I I I ENT <br /> i Ills ! I III I , <br /> 1111 I l � I I <br /> t i l I I I t <br /> A PA <br /> MEAST 11 E O/LY /�� <br /> Aop1=bVnAtpted 9y Llate ( Area Ernp(oy2e)[k u— <br /> J6 <br /> GmutinspecEanBy Dat / PECI L'JAW1 Permit <br /> PimrplrtspetSrnl3y ��\\ Y\Y)\iUY. �V� Ume J ) i� ( I.q 0 WAMERReMiVOIJ <br /> SOB Baring ritspecrort By <br /> Elate CorLsaucled Welr Depth a <br /> COWABYJs <br /> PE SC I RECt31Vad check-11 Amnon! Perm1U Imaicr# Well W. <br /> C�as_t_ Info J-B .I_-- Cash -- - milted Datr _ I SelvrceRe ester' _ .I -- I <br /> I ( I I <br /> I <br /> I I I I <br /> I i <br /> rrD-;3-� cntn <br /> 6 d VL9�18960Z Out s.1e111.IQ eoueln.rnd e6t 01. 61, VZ Unf <br />