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AUG 3-2007 10:08A FROM: 209BB73574 4640138 P.5 <br /> 1 WELL/PUMP PERMIT <br /> 4/ SAM JOAQUIN COUNTY ENVIRONMENTALIIEALT11 DgmaTmm 600 IL HA418lrarl•STOCKTOMCA 9$201-(109)e6w3el0 - <br /> NON-REFUNDABLE PERMIT CALL 204 Y53-7697 FOR 1NSPEGr'rONs EXPIRES 1 YSAR FROM DAT&ISSVeu <br /> 2'1100, E. Frazier Rd. Linden 95236 <br /> JOn ADDYEE9 CITVr4UP ^ <br /> CROSSSTREST ClemerntS Rd APN065-180--a�AxcCLslzE ���-Z LAND LIS%ArrLlCAnf7mM .... <br /> 3 <br /> OwNcnNAmc Bev SambadD Barbara Costs olo PNONc <br /> OWNERAUD"x$ 7300 Fine Rd. CITVm.4?arur Linden CA 95236 <br /> CONTRAMA Purviance Drillers Inc. POONc Z0.9-887-.3554 <br /> C0NTKAC1'URADORT.0 P.1 0. Box 64 cr,,m,.Tvz,Linden, <br /> SUOCOrITnACTOR n/a PIIONE <br /> tPY <br /> SVOCONTRACTURADDRlv►S ._,. ClrrlSrATttrLl► _ <br /> LICLISS MC-37 0C�l 0D49 00dhar NUMAMR 3 7 2()2,- R%►IRATIOrr DATE <br /> GOGIlANUCALINPORMAT10N11. CoardlRukl X Y " Tawn►hlp„T RrnlaRvtlda- - <br /> c •� •- 0 Donu:rGclPdvHa IniptitnVAyNkuhural ❑f tmu(al 0 W9101%WIly ManRoring 0 Suit Sampl'ulyrChamclertxetion <br /> D Pubile Water Syynem <br /> Ifdia....A r;Oru.r: rte,.yu.u. wr —m W.k.at P.4 K".", <br /> Tin-Or Wim, ONQw Wall' 01tapiacomanl Wall 0 Wan Alloradaa/Modi(loadoa 0Other <br /> p Manitadnil Wall(a) A orwelb 0 SOA DaK*I) a or6wlap 0 00om mical a.r Janna. <br /> p Out-e(-&rica well 0 OOt OW,y.9Royal p Croµfa,mact <br /> $ Pump @X �RL1 <br /> n Weil0Now Pum 0Ilum R lie rDcnl e <br /> SYla.L Cn.,arxucrrov <br /> Drilling Mv" 0 Mud Rosary 0 Cr Rotary 0 Auger 0 Cabla Tool O Push Point G 011KF <br /> I,ropusod Well Depth r R E%euvatlall ht diunloter 0Opm Dolton 0 Oroval Pack 1 Qmvol Sire In diamcter 1%0 <br /> r 0 Conductor Cuing In di..Twm r Conductor Clog Depth B 14* <br /> Well Culag Diamatar I- In T1,icUmdOau0ASTM 8dmd p Steel O PlaMlo G SWnJeM Steal 0 Olhcr <br /> GIVVI Seal Dopdt D p Nwl Cement{flt fb Dag!I�lO gal tturarJ 0 Sand Canwm ,curt mos/7 gal water <br /> Cl Bon10R11a(9O%eoudi) 0 Mraujikuuvr Spec%solids_„U Nana Cl Spool M Fib a Spica Sahmlned C <br /> CM(Pl#c9m1cJMctdad t3N ad OFMOP411 13OMur pRlnlltdaas/AlxolanlOr{Hama► fY, <br /> fJ,plama`- —WWW By F C)Driller O Pump Coasmia 0 Odor �, 1 <br /> 0 CuacreO Peduttnl Dlmeoalaim Wldlh 4 Lan rh R TH4 In 0 Cbrilry Bac 0 Slave PI <br /> t 0 Submorolble O Turbina C]Otlnr F1P P Sal R 9mndhl Water Level h <br /> 1 U211IL pY CBRTIFY THAT kl HAVE PREPARED TILS APPLICATION AND TILAT TILS WORK WILL 81 DONS 1N ACCORDANCE WITISAY <br /> JOAQUIN COUNTY ORDINANCES.STAT&LAWS,AND RULES AND REGULATION& I ALSO CRRTUrY THAT MY REOUIRED LIIce s IS <br /> CURRENT AND ACTIVE W1Til THE CALIFORNIA CONTRAC ORN STATE LICENSE BOARD AND TltAT.i AM IN COMpLLINCE WITH ALL <br /> WORKS COMPENSAT <br /> IN 51 24 ILOLIit AOYANCE N07'iCE tiEQUIRED FOR INSPECTIONS �11 <br /> T,t.LUCorparate Secret4xZ 8/3/07 <br /> r y�. <br /> . t1� <br /> r <br /> l <br /> 1 <br /> PAYMENT' <br /> RECEIVED <br /> AUG 3 2007 <br /> S NN JOAQUIN COUNTY <br /> ENVIRONMENTAL_ <br /> EALTH DEPARTMENT <br /> t <br /> l)YPARTMENT 1,1181C ONLY <br /> ApplicaGmn Acceplad Dy v" Data tS •3 C?7 Arae - 8m4loyco IDM <br /> Grout Inspection By Dale ❑ SPECIAL Well Permit I <br /> Pump lntpxdon By Dain GI WAIYRR Recclyed <br /> Con.tractrd Well Dol.tb fl <br /> COMMENT'S .+d UJ,.A-i(1 5 -4C.- Cd '-J 4Z.'Li C'7-71 :1�I c-CL' 4 `J <br /> C'FJ i 14C�u r fv� P c.0 �.�a- r n1s�r rri n� A i G Oil <br /> I'll SC R"red COKUI Amount DaV Yarmlli Insulter YYcIIIUM <br /> Coder Info p os m 8e I 8 <br /> y3�1 Tic> Sv.L b7 <br /> A <br />