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Crryajp Lodi, Ca 95240 PARCEL SIZE- <br /> OWNER NAM9"ttlehale <br /> IZEOWNERNAM9"ttlehale Vineyard, REss P.O. Box 885, Linden, Ca 9 <br /> cyr,jp Victor, Ca 95253 PHONE <br /> CONTRACTORLuryiance Drillers,Inc. ADDRESSP.O.Box 64 <br /> Crryalp L i n den,_-2A 95236 PHONE 209-887-3554 C-57 LICENSE1t 3 7 7 9?EXP DATE 7/0 1 <br /> I GEOGRAPHICAL INFORNAIATION: COORDINATES X---- V TOWNSHIP 3 n RANGE 8 e SECTION 1 /2 m e s E C 13 <br /> TYPE OF WELL: jo NEW VlELL ❑ REPLACEMENT WELL ❑ MONITORING WELL p Q OTHER <br /> -- INSTALLATION: ❑WELL SYS713M REPAIR ❑CROSS-CONNECT REPAIR 0 VAPOR EXTRACTION WELLS <br /> TYPE OF PUMP: KI NEW ❑REPAIR H.P. 1 5 C? DEPTH PUMP SET 3 0 0 Fr. FIRST-WATE I NSE!, <br /> ❑OUT-0F-SERVICE WELL ❑GEOTECHNICAL Ii ❑SOIL BORING ❑DFSTRUcTI6W <br /> INTENDED USE 11TE OF WEL CQNSTR 1 TION SPECIFICATION <br /> ❑INDUSTRIAL M OPEN BOTTOM WELL EXCAVATION DIA.222'� CONDUCTOR CI SIIYAPIA <br /> ❑DOMESTIC PRIVATE ^ ELL CASING TYPE,s teel LCaSWGIDG[ <br /> ❑PUBLIC/MUNICIPAL ���� GROUT SEAL DEPT.tI-4-2"8' 326 SPECIFICATION <br /> .250 <br /> r §1 IRRIGATION/AG C j� OTHER GROUT P,RAND NAME <br /> ❑MONITORING S 1 ,� V,Y� yy"" GROUT SEAL PUMPED: ]YES ❑NO <br /> f <br /> O CHRISTY BOX ❑c CONCRETE PEDESTAL RY DRILLER: ❑YES ❑NO <br /> APPROXIMATE WELL DE <br /> PROPOSED CONSTRUCTIv vvKlLI.ING METHOD: MUD ROTARY__AIR ROTARY AUGER CABLE OTHER <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. 1 ALSO CERTIFY THAT MY C-57 LICENSE IS CURRENT <br /> AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL WORKMAN'S <br /> COMPENSATION LAWS. <br /> ' NI 124 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br /> r <br /> A <br /> SIGN o <br /> .�L TTfI E Corporate Secretary DATE 4/2 6/01 <br /> I � <br /> i <br /> i <br /> I <br /> t <br /> DEPARTMENT USE ONLY <br /> Application Accepted.By tom'V - ate i v Am. -( <` F.MPIDN <br /> Grout Inspection PyDate J-'b-O/Pump Inspected By _Date <br /> V <br /> Destruction inspecti y Date <br /> COMMENTS: SYo� q�� r, Date-- <br /> azo x� Q.�vc� ?s< �v YPS 9 r r5 k <br /> T94"('.641. 41051 KS �� <br />