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R[tib 'ON Wd [0 :ti BI0 '86 'AON aUail p;Aiaaa� <br /> IJVELL'PUIMP PERMIT <br /> SAev Joneu,.+r Caunw EwLgcvy,ENrAL H Ejr-TM D SPAR 1rtF yr T asg E1sT HAzS-TO N AvEVUE-Sha MxTa.'+CA S:iM5-IW9)a 5&;ata <br /> kNOW EFUNDAHCc PER; T CF1LLP-09 953-7697 FOR INSPECTIONS EXPIRES It YF-AR MOM DATE ISSUED <br /> m <br /> �C — arrmPGio'1G10 �� <br /> J03 AaaSt3S '' •� <br /> CRn SSrtEEr PAaCFi 52E m US E APPIJ CATICSt� c <br /> a <br /> OwnER Nati .m PrtarJ=, Ln - <br /> Ovry=_gaoars tC)DS�(�lc� C�;� �1 <br /> CoNTRA=a ?urviance Drillers , Inc PHavE 209-887-3554 <br /> COYnu CTaR ADDRESS PO Box 64 Cr11/S1A1VZl,Lin d en , CN 95236 <br /> SUSCOWMAmrt <br /> ISUBCOhrTRACTORAQLRESS CITYIS-ZA CtP <br /> 377923 7/31/19 <br /> L7cEY5E GSI U G61 U D-69 ❑Other Ivllslli�2 FJLPIRAnaN DATE <br /> Dor. meCaJ�LS.vPEe�=GeneralWneral(CoTiformBacteria(4391) (4392)-�-Arsenic(4393) <br /> [.vr�mp UsE O OcmesCrrlPrfvate nigarion(Agricultrrei G Induslral G VYaterQuaGty`fonilonng O Sail SampfingrCharacaerimRon <br /> j 0 Pubtim Werter System <br /> j dcazatet firm Corer .-Mer bran° G-=zl Name or Phi rtomte <br /> TYPE OF Wows G Neer Well 'Repacament Wel ❑Well ASte'alioM':.a dfi©tion O Other <br /> n Manit3tio9'NeU(S) Sof%WL-; G Soo Barng(s) Fartvriags `Geoten1cai <br /> C.out-0fSeMce Well C Cul-OFSetvica Wel'Rene%%ml D Crazz-Cannerrion Repair <br /> Neer P :t Pump rrment c pcwp RC r D RaLse Well C.-In <br /> Wiling Method D Mud Ratary C Air ROtay U Auger 7 Cahle Tool -1 Push Pam r-1 Oilier <br /> Fmpused Well ❑eplh h E,=r ition fn Smmeter =Open Botkm E Gravel PacWGrevel Size in c9arneter <br /> 6 Ccnduetor Casrttg in dmneter ! CanductarCasing DEplh `t <br /> Well Casing Diameter_in ThicmessYGdllgelASrMSrhed =Steel ?Plaslic U StautlessSteel C 01-her <br /> Gmutsea( Depth is -D NeatCement(GIFM U S8ndCement saekraxrlgal wat;-=r <br /> C Benteni1e(2MS0QZ) J Other <br /> GmatPlacementflethad a Pumped 0 Free Fail U Other a RelasdarrtlArceletalar(rmuc) <br /> EtgEx=l- I.. led By O OrEler 3 P=p Canlractar ❑ Other <br /> r Can tsetePedestal r0!menslonS- tVj h R Length tt7Terk in -1 C"stYHCz O SIOVEPlpe <br /> PuesP SutunerybteU Turbine J Other EiP Pump Set Il Standing Waler Level R <br /> 1 t.ja;EBY CERTIFY THAT I HAVE PREPARED TAS APPLICATION AND THAT THE WORK WILL ISE DONE IN ACCORDANCE VM-H SAN <br /> JOAQllIN COUNTY ORIR"jN'CES, STAT-.LALYS, AND RULES AND REGULATIONS. 1 ALSO CERTIFY T1iAT MY REQUIRED LICENSE 15 <br /> CURRENT MID ACTIVE WITH THE CP13FORMA CONTRACTORS STATE LICS%SE GDARD AND THAT I AM IN COM'.DMNCE WTH ALL <br /> WOR PSi'SA710 <br /> MIN ] RVI VANCE NOTICE REQUIRED FOR INSPECT)ONS-PLEASE CALL(209)953-7697 <br /> 51c Torporate Secretar�A,� Z� <br /> I it <br /> I ! I I l i f I I I I I I I I •`� ����,°�,. .,, <br /> I I I <br /> l i I.I. i I o 2®18 <br /> I I I I 1 I I IL; Q/1i,Y <br /> RON� cc�r <br /> H <br /> I I I I I i 1 �FpgR �4�Y <br /> I III I IJX I i I <br /> I I I I I I I <br /> I I I I i I I I i <br /> II <br /> I i I i <br /> pE ARTMENT U E O LY /,�� <br /> Appli Qlian A¢ePled B3' Cate �v/ Z Area-I�� — EmPioyee I V V <br /> Grout Inspectlan Ey l Cale SPECIAL Well Permit <br /> Pump Inspection By � �5� �c� ❑ WArvaz Received <br /> Sol Borina Inspecilan By Dale Constructed Well Depth it <br /> COLAM[MS <br /> PE . I Received Check* Amount Permit! tnvolcv Y- _ _ -Well lDe <br /> ( Codes__ Info. _ ____ _ - Tilted Date S ce F2 uest: - I <br /> _ I <br /> a a esrne �-1 J 23 <br /> 8 d OUI Saalllaa 801-lelAind d0`; b0 9 L 8Z AON <br />