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ti61- "N AVIS : H 6102 V( '111r 11111 P I a�a� <br /> WEL.UPUMP FIMO T <br /> San 7oAamviceumEllVlrto`ruia[rnLHEALTHDsPAltvatrerr 78fiBEaSTHAZr=L7UNAVSVUC-StiU0MNCA95205-{2D9)4ZS-3420 <br /> NOWT-REFLINDASLEPia— CALL 2U9 953-7697FORINSPEC-11ONS EXPIRES-1'YEAR FROesDA-MISSUED m <br /> Iona AnoR� 20520, f/E acalRpo Rdn cn-rJav <br /> Clements 95227 <br /> lGRos5�7¢-� �yiV APN (;/��✓S�I / Paiicf7..SY� O.O LnNL 115E APattr�Tldt1� <br /> I Rand Sliva I�to�7097�7-31 ag <br /> OV5'N3t NAIL <br /> Ov��Aonsz� <br /> PO Box _175 CrraS—� C: e:- s CA 95227 <br /> cOrrr;VcrOR Durviance Drillers , Inc altolr 2n9-8 37-3»4 <br /> Conn-IAcr=AnaRtzm PO fox 64 CsaI.inden , CA 95230 <br /> 'S 11B GtsJ-r'{aGTOR FH011:: �f <br /> sttneaveRAcrauAnoJtss ��'� 1 9 <br /> Isms C-st U C-61 -D D-a? n ower Nuumt 3 7 7 9 3 E5watAnav DAr. 7/3:L / <br /> posFstxt spit=LLc r rn=�General Mine211CoMm Baclelia(4391)=piOtOmochl0[OpmPane(4392) Arsenic(4393) <br /> kTrEN=(ISE DmnastmJPrivale C Im02liic"AWculturat C Industrial C VVau.r CuaLty Mwuice�ng O Sal S.tnpfingl'Chaacluimtion <br /> Pubrrv`'z system 1 <br /> Vdirwm[Lvm(anxrr_ ttGterS}stm�`-nc Ccmxc N7�ar P.'m�Ak�Sr <br /> TmeoFL'lOw C Neter Well C Repta=r.mtVLre1 G Wa9AIle01her <br /> ManimmgNlea(5) mar�tVls G Sot)Boling(s) ^OtLO"-- C Geole=tC21 <br /> E OUL-0FSertim WPj! U 0ul-0:�Sen1vm We1IRent— I D Cr=-CoRIIs3.iEOn Repair <br /> C,Neve pump Pwn Replacement C Pr.. Rc air 3 Ratrn t7t6'�ll Cas[n <br /> WELL Co}1marTm" <br /> 11L ilTrnghletJmd 0 MUo Rotary C A:r RntEr 7 Auger 'A CeNeTaul 7 Push Point E OCL..' <br /> (Pm Posed 9Le11 n diamelcr C Open SoUrn C Gravel PsrJdGravPJ S= m diameter <br /> G C=%fuclorCasirS inSmnreter I CanduVwr Casing DEpIh fL I <br /> Well Casing DjpmeW_in ThcknesVGallgefASTM Sched =SlerJ =Piastre E SIL-J :7 Dthu I' <br /> GrautSeal Den lh r ]Neat Cernmt(941b traar10 ga1>•rater) -_•Satd Cement s2ck mall`gal waier <br /> C Eentmliie(2 %saGds) -1 OIner <br /> (Grout Pla�nt[Acthcd a Pumped 1]Free Fan -2 Other .3 Retatdantllucculcatar([ffiue) <br /> f PmESTAL trmtalied By ❑DnTt• 7 Fump Cvntaaidr C Other <br /> r?Gancmte Pedestal C[7lmensiors_V�dN P Len91h RTtti.�c in 7 CJrr152y Eos J Stave PJpe f <br /> PUntP SUhroels•ble❑ uroine O Olne[ HP PwUP SPj R Sond7ng WalerLe.P1 R <br /> 1IEA1- y CUMFY THAT I HAVE PREPARED THIS APPL1CATiON AND THAT THE WORK VALL BE❑ONE tN ACCEE WRE <br /> QR MCISAN <br /> JOAOLMN COUNTY ORDMWCES,STAT LAWS,AND RULES AND REGULATIONS I ALSO CERTIFY THAT MY REQl.MM LICENSE IS <br /> CURRENT AND ACTIVE Wi3H THE CALIFORNIA CONTRACTORS STATE UCEP6E 90-ARD AND THAT I Ara IN COtaPt1ANCE WITH ALL <br /> 'Il0 IPENSAMN LA <br /> I MINIM 9 241 HO CE NOTICE REQUIRED FOR INSPEGTIOIIIS-PLEASE CA" {209)95 Wt <br /> Yf.� TrtCorporate 5ecre�ar�A� to I <br /> I ! 1 I <br /> ( I II I I I II i ( ! 11 I I II <br /> ! II I II I l I fl ! I II i II <br /> l I i I Ii II 1 ! 111 til Ili A��E <br /> i I I I 11 J 1 I I i 1 I ( I ( I I I ECEIV�T <br /> ( ( III I ( I I I ( II1 ! I I E® <br /> IiII it I ( i i ► li it I ( ( I II ( I N262019 <br /> I II II I II ( III II ( I It <br /> I ► I i ( i I ( I 1 1 w' AQUIN COU <br /> 1 1 1 I 1g IRONMENTAL <br /> II 1Y <br /> DEPARTMENT <br /> 11 f l iI I I I 1 IL <br /> Ifl I I I { f1 i <br /> P TAS ENT I1 E LY <br /> AppGcrlion A�pfed By P3ea E-mQldyeel� <br /> G mn InperSom By Date U FEVER 1 ec Ped <br /> r [� jPJAtVr�x Received <br /> Solt emins Inspection Ev Dat-- Constmcfedwelf Dept, R <br /> COMMENTS <br /> ?E SC Received CEtaelt�J Amount oda Perm[tl I Invoi :� V:eOIL <br /> h ._._. _Rermitled --- <br /> i <br /> I - <br /> ( I <br /> d VZ9U2960Z OUI sJaIII.IQ aoUeIA.ind e69 OL 61, bZ unf <br />