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ZlS� "N A,JN : S f 10Z 'LOIS IWI J paAl ;);� <br /> TfELUPUMP PERMIT <br /> Q <br /> SAN J OAQUI-J COu7J7Y ENvmWNrAQ4rAL HEM-7rU DEPAR IV 9Pr 7 86 8 EAsr Hgza-Tcn ALzuuE-SjorKToN CA 95205-1209)469-3420 <br /> J <br /> W w u Q �IVON-R¢uNaJa.�J�P»,-crr CALL 209 953-7697 f-0RiMSPECTTONS A'PiRES I YEAR FR0L1 ATE Issut_a � <br /> Z3(114 E Campo Rd a..mP Clements95227 <br /> � = aaAnaR� �� g <br /> > o J Johnson Rd APN F�L3�(�r�S rAsz�s�lL�,v UsEApPucnTlQaF <br /> V <br /> C <br /> Q Markus Bokisch Ranr s z& /g U` o"=��A-64699 <br /> 0o awNER Nu.L <br /> W w oven anaP n Rnv S / fox 11k3 Crrvisrnr=�p ct°Or CA 9 ri7 5 <br /> V til ZIsuscav-rRACTUR <br /> G0gmacraa -Purviance Drillers , 17C PHa� 2�6-$�7-37a� <br /> W L0 PO bog 64I�,,, Linr'ten , CA 95236 <br /> CwjmAc7aR i1=R <br /> PHQo <br /> Z <br /> w i5tlacovrRac ioR AntrR�_ G77'A57A7FJZIP <br /> IllcErls= cs ncst aaa nOIItEr NuniRR <br /> 377923 Ea�a�I�DAT. 7/31 <br /> Oar -cN1aL5A L rrc=-UGenaml[uTineralfCoG(ocm ear <br /> teia(4391)=DPonz7lechlompmpane(9392)=Arsenic(4393) <br /> IM-F-Wom USE D DuMuSkJFrivale IuioatiwdAgiicultural G Indi�urdl C 4Va:cr DuaS,ly MamTgring C]Soil Sano5ngJCFraraderi-�Gon ' <br /> CC Pub6cWdLrSplem <br /> "dSF�en;h0[IIOrrter :i�erSysl^mlCarn Cgrezrih7.r�•acF1'e�Ncrr7tr <br /> TYPE OF.JORK Q NF11 WWI C RepL�j Wet C Yell PlfOlhL�- <br /> Q1nml9ting Wet(s� �aF�•rdts G Snt Borin9(s1 TOi�"p°� >=GeeletJmicai —Cftrcn`�� <br /> Out-O FSe1+fr2 Vlell zit-0:SenEM Weft Rrie•2l 7 Crass CmmECkM Renat ,�7� <br /> n Newu <br /> atum <br /> o G Pp RepI-ce.n m ]Q`Pump RCFair 7 Ra.eWal:Casing p�$_ IwIj®p-r <br /> W=- COPIMMICT1 ON Re ]tl <br /> 'tW01mg Methad D h1ud y RcteC Xr-Pntav O Auger 73Cable Tao'; 7 Push Paint � Olhcr • <br /> Pmposed weft Depth tt ExavaUan in damele _open Bottom G Gra•.21 ParYlGrava?J Sae in <br /> C ei er <br /> Canduclar casng in ccm (^ <br /> ur <br /> eI C,ndudarC�cmg DepOi Pf1 20�� <br /> I Wo,11 Casing JYizmEt7_in Trid4tessJGauge1ASTM Szhea - ?P <br /> Sle23 la',' r-is Stainless Sleet D Dltrr lJ <br /> G?nutsezi Depth 7 Neat CernEw(94lbbec.s40gal vrdLe> Sand Cesnenl sad. <br /> E <br /> e 9&Itanifc(20:5 scuds) a alt e ME� <br /> NTUNTY <br /> Grout Pia�rcant Fdet}xid J Pumped I]Frye Fan 7 0111er-- 1 Retudant1A¢elem1or(rmme)___ � ARTMENT <br /> P E^E5rGL IusWfed by ❑❑i fer 3 Fump Ccnracdar ❑ Other <br /> 13 Godcrem Pedestal CDlriterisfons Widdt ft Letlglh ft Tfick in '7 Ghris'il/B� 7 StDve PJpe <br /> ;Paolo a75ubmemhf Turbine ❑Other iP P.-PSet 11 SlandngWalerievrU ft f <br /> I HEzR.—'3Y C Tir"l'TRAT I HKI E PAEPAPZD THIS APPUCATICN AND THAT THE WOPJ(VOLL 6P DONE I4_ACCORDANCE wrm SAN <br /> JOAQUIIV COUNTY ORDIMP.NCES, STATE LAWS, ANO RULES AND REGULATIONS- I ALSO CEFMFY THAT MY REQUIRED L ICE3ZE IS <br /> CURREI•JT AND ACTfVE WITH TRE CALIFORNW COVIRACTOl� STATE LtCE16E ADARD AND THAT t Aril IN COIVJPIJANCE VlR7 AL <br /> `Af0 aD�z <br /> ib�lPAI Z$ VANICE 140TICE REQUIRED FOR MISPEC71ONS-PLEASE CALL(2031 53-7697 <br /> s ,Corporate 5ecretar,�A,L -l��i� I <br /> IaI- <br /> II I n l fl I If I I ! <br /> I I II c 11 I r JJJ I <br /> rilI IIIIII <br /> ! ! Int li j I I I I Ili ' I1 <br /> IIII II II II IIl Ill <br /> Ill I II I I I I I 111111 1 til <br /> tl 1 fill I II I I I II 111111 <br /> II IllEl II f II I l lllilllll ! I 1 1 <br /> tF T TI Ill ( I l Il l fllli IIII <br /> 1 IJI ! I I I 11 ! i I I II <br /> I f I I I I IE llll I I EI III ; <br /> I ! I 1 ! I I ! I 111 ! fl ! l III <br /> 11 ; I I 111 If I I I I IIl <br /> tll II I IIII <br /> 11 V I I I I I <br /> Ifi I I I ' <br /> Ep�RThTcN7 <br /> Employ"304 <br /> E O LY <br /> Applirztwn Accepted By <br /> l ?a E Ara <br /> Grout Impeclicn ay Cale PEDAL We <br /> Gril Permit <br /> Pumpinspeclim2y r r Dae v I _ WuvmRece9vod <br /> Sd7(3orin9 insFecfion By Dale Canstrurled Well Depth ft <br /> COMMENTS <br /> PE SC Received Ch Gd! Amount FermiU I fmroicen we]IIDW <br /> Ca ..s_._ fnfo _- __By__ _-- - _ _— emitted Oaf Semire.fit westm__ - I - r <br /> 114 FQ0 4 01 04 <br /> I <br /> I i I I <br /> 1 <br /> 7 <br /> J <br /> .-BL rug P�eir <br /> 9'd VL9U226N `(�, ( QUI s.lalll.iQ a0ueln.md d8 L:b0 61- L deS <br />