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• A .�ir� <br /> GEOGRAPHICAL INFORMATION: COORDINATES Y_ TOWNSHIP RANGE- SECTION <br /> ! TYPEOFWELL: . NEWWELL . REPLACEMENTWELL . MONITORING <br /> iINSTALLATION: . WELL SYSTEM REPAIR . CROSS-CONNECT REPAIR . VAPOR <br /> 2/0 Typt 1 1'_MA . . I' <br /> * i • '� <br /> INTENDED US TYPE OF 1 1 <br /> ■ INDUSTRIAL . OPEN BOT70M WELL EXCAVATION1CONDUCTOR 1 1 <br /> XDOMESTIC PRfVATE ■ GRAVEL PACKISIZE__ 1 1 1 <br /> 0 PUBLIC/MUNICIPAL 0 DRIVEN GROUT SEAL DEPTH- SPECIFICATION <br /> ■ IRFUGA7ION/AG OTHER GROUT BRAND NAME <br /> 13 MONITORING GROUT SEAL PUMPED: 0 YES 13 NO <br /> ■ CHRISTY BOX ■ STOVE PIPE • • DRILLER: ■ YES ONO <br /> APPROXIMATE DEPITI <br /> PROPOSED • • /' 1 •1 IROTARY- , <br /> PREPAREDI HEREBY CERTIFY THAT I HAVE THIS APPLICATION1 THAT THE WORK1 DONE INACCORDANCE <br /> JOAQUIN COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY C-57 LICENSE IS CURRENT <br /> 1 ACTIVE WITH THE CALIFORNIACONTRACTORS BOARD AND THAT I AM IN • 1' 1 ' <br /> COMPENSATION <br /> iU • • • • INSPECTIONS <br /> SIGNE <br /> ■ins►�..............................■....■ <br /> ■'�Iu lel■I■l..I■.l■I■l�..l■I■.II•I■.lel■I■I■I■I■I■lel■I■I■I■l�l�.ltl.l� <br /> ....��i....l■l■lel■I■t■1�.�.■I\\...■..t�......�..■ <br /> I■(t•...I►�l■.....t�.a■tom....■■1............. ..! <br /> ■....W■.l■I■I!•..l■lel■.....I/��....t�........■■.■ <br /> ..N.a9■...... ME <br /> ■�. �Immmmm..m■....t■.■N.. ......■.■■■■ <br />