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OtiES "N M O :ti 6106 6 '2nd ;wit paAl ;�;� <br /> WELL PUMP PERIUB <br /> �96HEa.,'"r};�Ta11Av�NUE-SiUCf(70N CA 952D5-(609}4�9,✓ <br /> Sar+Jotwur+CauNrYFliws>sNx1 LlEEw--MB01ARMEMT EXPIRES1YEARFROMDATEISSUED <br /> IMON-RPFurtDaet�Paz�mT CALL 09 953-7697 FORINSPEC7iDN5 Linden CA 95236 <br /> Jaa An t�'� 7401 1. Q. O � o <br /> Comstock Rd AP,, Pasco s>� LAND USEAPPL rlTInH <br /> c'tosss7,:�r 209-406-9991 s <br /> FHOM1G y <br /> 01VN52 NAf�E <br /> � <br /> ox „sT;LT-.izjPLinden—CA 95236 <br /> Purviance Drillers , lac pfmE 2�g_ <br /> cctrraA crap PO 'Bo x 64 TL!n 6 en, CA 95236 <br /> cc:rr�acrarxAourrEss <br /> Ftcor.= <br /> SvaCoN�tCSOR <br /> S'UE1CQMRACIDR AMMESS CTIY1S7h7F421P <br /> - 377g�3 7/31/19 I <br /> seise csr a 6si o-� n o� MuMR� RFoI+DAr <br /> uo s 1clnlE�Saas'=td�C Cveers!fuLneral/Cofia m Bay etia(4391) QinmmochlarapiaPane(4392)=AtsFluc(4393) Il <br /> LVtBfDEOUSE '6 CamBsl�FflVate -_-(r502-rJRgria+uu;at C Industrial C WaterOuaGtyM=mCrs3 O SalS�npT�glChara"�-�'�+ <br /> O 11 <br /> P ubFeV tater 5yslr T' vaasy�m u� ccnr¢[mar vnrn-G m,ocr <br /> udu[amt Gcm Crnec <br /> TvPeO�VVotuc C New plan C Rep#set=ent WeL G WCII AI R`la'fnnRdCC> Pian 7 Olhet' mar ��� <br /> 7vAnTcdngWell(s) 9afw2fls GSodEu*-9ls) »aitaongs L-L�aIeGET1�7 <br /> Oul-ofSernesWell O Out-Deres <br /> `.SismMW RenU CmssCcnr�lim PsAafr ���'�Nt <br /> G Newr FumP F Peon R latrsnen[ P alr 3 RxiseWeTl Casin <br /> P <br /> ,�v�corSrANcno^, <br /> OUter q Gn <br /> 1Mr ij1dngMrethad ❑Mad RalarY G AlrRatriy O Auger 7 C'�hteTaal 7 PusnPmne U <br /> Prnpa=,ed Wci1 Depth it F=2valicn in decneter �Open aatlam C Gntcei PacWGratirll Sas meler 20 <br /> GCandut�orCasng in drat=eler 1 CondarJnrCyingDepth ;e � QV/H �� <br /> 7NeIl��3 D�ef�_ n Thddaw-vJGaugeLASTM Schur[ ::SteeJ 7 Pia,i c sln�� -3 amer._� pNM�d�N�, <br /> Grn=us� Depth-----J, D neat CemEnt(4fob�}ya galt��l Sena Cement Sari rmr_ �Pq��� <br /> 1::HenlamW(2MS safids) ::10 F/yT <br /> er0a=P3acamencf0ethad L Pumped ❑Free Fall 7 QUiar O Rpbrd3nt1ACCEIff3l0r(frd=m:) -- <br /> am>srA� f mtal[ed By D CrEjer 7 Fwnp Canifadur ❑ Other ft,rnlck ;n -1 eltristyEaz 0 SrouePipe <br /> L=Gortccete Pedestal GD7meas9anr.Wdh R Length <br /> PueSv Suhmp WoTarnine 701hv Kp ��2_ Pump$PI tt S.alt�rt9WaterLEMI ft <br /> 1 i-i -aY FY THAT 1 HAVE PREPARED-CHIS APPLICA-RUN ANN THAT THE WOKS(WSLl BE DONE S0.'A=Rup'MCE W T14 Sp'N <br /> JQAQUW COUNTY OI�tNRNG6, STATE LAWS,AND EiU1-S AND REGULATIONS_ I ALSD CEFMFY THAT My REallIRED 11GENSE IS <br /> CURR84T AND ACTIVE VJrM THE CAUFORNTA CONTRACTORS STATE LSC�ISE F30ARo AM THAT i Abd IN GOR7PCIAIVCE WITH ALL <br /> r <br /> t/�pCOfi3�E1I5ATIO�LA <br /> MINI 10128 U V CE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL 1209)95 -7 <br /> 697 <br /> G2� 7,Corpara�e Ser=r etarY,, Y <br /> Sty <br /> IIII II II <br /> I i 1111 f ! f [ I1 � <br /> ! ! 11 III till II I ! } I Il ; l I <br /> I ! 11 ( ( ! ! I I till I ! Epi III ill II <br /> f ! li I1 ! I � ! III II <br /> IIIlI I I ! I I I I ill I <br /> ll [ { I II I I I I11 <br /> Ifll ! III ! ! ) I I II I I1 I ! III <br /> l IIllf I ! I I I II 1 'Il ! I <br /> I f I I I <br /> i ! <br /> II ! I I illi I Il III li ' <br /> 1 1 1 I 1 I I ! I I <br /> ! 11 11 ! 11 I I II Illi I f IE 1 II <br /> ! I 111 i II IIII II <br /> If ! I I I1 I ! l <br /> eEppRTmENT U E NLY <br /> /— (3 .1 /- `'( Arno — / matavzel (/lyi,✓Lf� <br /> ApplxzfAn A uplad BY I/ c Date <br /> 6taut lase echos BY <br /> Dale D SPEt:tALUUeI{Permii <br /> Date I o WAFUER Received <br /> pump IttsQe>�an���`�� GonsLvtSetltlYeli Depth R <br /> Sog Baring Irsprd+an B7 Date <br /> CO uirdIENTS <br /> e PermiU lnvoir.# <br /> PEai <br /> ScSC Receivad Chacluu ptrtauni Service.RE4uest <br /> Cede, _ Inio_. - <br /> I <br /> EF�as 2.otrs <br /> Z-d bLSEL8860Z OUI s.lelll.rQ eeUeln.md dOZ 80 6L ZO End <br />