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a1:T <br /> . •� CER-IT 40. i <br /> E-eTeo ndo, 1:n1; 4!F_- -I Dan ISSUED 4L��-$�. I <br /> c\•;; _n•IPES I YEAR FAMV. 1"E ISSUED <br /> (Complete in Trlpllca:e) <br /> PpD11uL10n IS hlrety ^hide to '+Auuin local Health <br /> District cl for, a Cent[ t0 NO. S4r.l or $" Int all the 6Or4 nlrrin <br /> �i!ance with Sen !oeou+n CeuntY Ord tnantt No. $49 lOr uwage or NO- 1867 for rel l7 DumP <br /> described. This apPa ca•.m" "d"" ,\:.u•n Tocol Beelm Dl ttr'ilit",a. <br /> ddrlsS <br /> and the Rules r0 R"Rulat in t•' S4Den to" _ <br /> Job Address A-`t1�� �-Y-est <br /> Owner's Name ._�_`_'C�- ��\ C, Phone C) <br /> LE E__wtt�1` -si lore Np. -1 _I. <br /> Eon lfatt0r'S Name W <br /> DISPOSAL FLD,,;, REPLACE°ENI IWELL MOLL LI C!-1 <br /> TYPE OF WELL/PUMP WORK; - D OTHER t <br /> P._P...' ;4^aLL'•'i°4 I_ SYSTEM REPAIR 1`I U PROP, LINE <br /> f ISTPNLETO REslO SEPTIC TF•.+ — SEWER LINES CTHED ,Ell DITSISIR!PS OP <br /> fQU43AT';S _ PGRRULTVRE 4CLL <br /> INIENDCD USE —_-_-- -�•�` rR06lCM ACE0. CONSTRUCTI9N 11 11 ICAT IOVS <br /> Men[eco D/a, of Well EtavatiOO -�._-- <br /> Industrial !1 - t `J 1". of Well Casing <br /> r"i Srn v.., •+.. -_ Trac' <br /> L,DOmisti CyPr+Yate ._. <br /> I17 Public L_J Dela Typo Of Eating �-- <br /> .r(, 0 Eastern Spec l f itationt <br /> `j irrigation _ -. `In <br /> D Cathodic Protection IMPtU of G'Out Seal _ <br /> LI GlIphys kcal type of Grout ��---- --. <br /> D Other Surface Sral Installed by <br /> Repair WOrE Gone� Type o/ hr <br /> H.P. State Work Done <br /> ' --- --_ Sealing Material (too 50') '—'-- - <br /> Yell Destruction C) Well Dia-nttr ___- filler Material <br /> atate is (DtAnr 50') <br /> Depth __-_-- ' <br /> if <br /> 0.[rAIR/ADDITION 1-1 (to Aortic think or selpaR! pt available ewithinu200c feet.) Is <br /> TYPE OF SLPi IC 7;`0.n: ht4' I4SP�I.:': , <br /> Cmmer ial K OtnnrO���� <br /> Installation rill serer: F trl,,,•t:• <br /> --f-- lot t+te w <br /> AumDer 0! I�vmq units: ` '•°-�"r n1 bedroom Water`•� _ oat<r Table w1eDtN <br /> Character of '00 to a dCp(n o' ' •' ' _ 1�-�a�..y-- !—!��tt II.-11 No. Iftmartnet+tt �— <br /> (eMcitY , ALV - n <br /> DTIC TANA <br /> SF 'Yr"�ww' C.aNLtf. .B---- Method Of Disposal <br /> (apathy !: <br /> PAG. TREATMENT <br /> Property <br /> -rLine <br /> Foundato <br /> SEWAGE SYS'L° <br /> OES1R!+(7IM - <br /> t� <br /> _ k i..".... l+orsi ProMrty floe _ F -- <br /> LCACMING Ll%tS'p 'un±\tor _ _ <br /> rILIER BE' <br /> Sun Property_ <br /> Tnuatton Iine <br /> ln <br /> M <br /> 5L"'rS <br /> JISPUSAL POti!N <br /> •, a[rl lcel•nn and Anel the rprS will De don! In ecr ordance with Sen Joaquin county <br /> ertt \ r r„ realth District.r fort+Mnce Of the work for whlth. this <br /> I nrreDY c A. '1el 1 .�1\:•Ana o t SM Joe Ru in cern that [n the per <br /> ordlnances, At\tr L+"s, '' „rte riot inr "011owin,: '1 certify rY <br /> wp-e owner rr I ge"•rl e:."".'•y :+,r•,nn to wtr ronner at to Pet P"e "T'J't to "Or"'a't canDen Set ion of i r1 Ce i+rnrn <br /> "' '• the the rnrY nr runCh <br /> [,rt,fl-% Lre .pt1m.:"n; IT certify that Perl Prmante of <br /> r <br /> r r,;ia• s rr "1 " , ,. •,.blrLt to wnne-en's Crran tet mn Tars of California."l prn <br /> � �� -- Nl St 466-6781 <br /> ;Er.•.R1"['� USE r v a <br /> ,r.e <br /> Lodi 769-1621 <br /> - ..\; ._.. n7.• I )Q w 1!��J�=_I J.K. . .-I Yan tPta fl71.1104 <br /> ) Tr,,y RTS-6785 <br /> +oxer ton ar<., r,n, dM IODq, <br /> _ -wrtal "ret•.^. ___•__ _�_.___ <br /> EXHIBIT C 1 of 2 <br />