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..t t L_I/•r%I IUIJ t-(jt( WtLLf'UMN HEHMII F <br /> SAN JOAQUIN COUNTY PUBLIC HEALT14 SFRVICES <br /> 9 ENVIRONMENTAL HEALTH DIVISI <br /> EAST WEBER AVENUE, STOCKTON, ,,^98202 F EB <br /> (209) 46a-34.20 i <br /> NOR-AtfuAp Ili ppmq E7f11AEf f Yul FROM DATE"ju 0 -NVIRGi�i!vIi <br /> (co"16I6 M 11%4k.t.) <br /> ArTIICATION IS 11l1W rY MAnt to TNI SAN JOAOL"N COIN/TY FOR A$VRANT TO CON.iNt1CT ANDIOR AISfAII TNt WOlrl D1 OCTtN1fO To" <br /> FR nn IT <br /> JO AOVIN-Ot1NfY De�ILOP""T Tull.CNAMEII$-1 116.3 AND Tilt STANOARos Or"M JOAOUM COl1NfY MKIC APO -iOA M MAOI ' COM�11A !WTIII.AN <br /> HEALTH S(ITVICI S,d1VA10NAtIMT AL NfAL/N <br /> JOr AoOAI.SIOR APW# /✓ / S , IS 't'�� cm Marl –o �i9- �a-/L <br /> IVV , n �1 `�y7- / Q /� <br /> OV/N[RY NAME_ ( e I/ �' 111 n `B r _ADORISS y3 I V 1/a 1I B� /�ye. <br /> CONTRACTOR - rc �o/ a rJ(7< 111 A0611[fE�ZY° Ut l ���uc. I <br /> —3'c,` ir3l�uv, mow <br /> a,.co"tRAc To11 � �1 i✓1 AOfXtFfL uc��a is.Sl Oar 3� <br /> rM W WriMU►' ❑ KW Wnl ❑ KPLAc-e.*W VWUT❑�- kftwloowm%"t. 171 OTHER <br /> ❑ I11STN1J1TbN I]WELL WSTtU 11[►AM U CROSt COMAICT REPAIR ❑ VAPM EXTRACTION WRIT t I J <br /> U N.-U M� N�. DEPTH rvw I" FT. rWWI WATIR L1VEl 1 d <br /> RYrt Ds rtN try � <br /> ClU oln-O#osnv"WILL Ll MnrwwCAc WEu• ( Z Jn Not OfM1t0 0 <br /> LDISTI1UC710N+ �[J� <br /> ❑ 1 MOATMAL D OPEN BOTTOM DIA,Of WELL 1XCAVAt PO" NA.Of CONMKTOR CA0110O <br /> lJ D01AEEtIC/rnVATt ►❑--IT ORAVR PACKfwI' <br /> 1E TY (0!CALMK <br /> OItt IfrVC _ N A WA.Of W"t CApNO �V O <br /> �Uwy hIICI"0C.VAL 1.J or"m DEVIN Of 0110VT L[AL NtCIMATION TI' X <br /> lJ 11WOATKWAO ��,1 OTN1t1 OMOVT MAI WLI it, <br /> �--by Yl I�!� ORMIT tll,yp NAw <br /> ITSI UONIfOrrlq et <br /> \\\\ .[l Vi WE Al-Ptllgl D• IJ Yw W CONCRETE PEDESTAL ly bRAUWp YM lyl <br /> A\`"10X.D4TNtocl(010 CNESTIA SOM/1TOVe r.r! 'I A <br /> me"own t:T""Trll/C TTONIDISltt11O kmiloo, Utb ROTA"v AJRl1DT A1TY PUO! cAIR I OTHI <br /> 111[\ISY[t1I11FY THAT I NAvE fMPAR[O i►1S!Jll1C AT ION AMO iNAi 11111 WORK WRl SE DOM!W ACC0110ANr1 WTtN rAN)OAOl11N COIMTY ORTIIN AN('-t.,ft Al[LAWS. MJII.AND <br /> O(OULATION.Of 110 LAN JOAOUW C&J"V, 11344 OW.1..R OR LKENNO POINT'S SIDIIATLW CIPTIN198 TNI FOUDVANO: I CIRTwy THAT W 110E rIWOW AWV AF 114 FOR WNR:1t <br /> T1rS hRANT N tSSUtO,t wtAl.l MDT lt�flOY 14MOMS MJTCT TO WdMtMAN'S COaNlIf AT10N lAV1�Of CAI S'OR1rA.' CONTRACTORY{r WM OR SINCOMTIIACT"Sg11AT1 W CERIl1EI <br /> 1101 8x101"! •1 CERTIFY THAT IN Tilt NAPOWAWIt Of 1141 WOW FOR WHICH THIS PEIIAAT It ISSUED.I SNAIL IWIPWY KP40HO WMJICT TO 110010NAN'.Cf]1A/•ANoA LAWS O. <br /> CAUL OIWA.' TfIE ANT®1 17 CALL tN Ilotlla S FOR ALL REOIXRED INLPLc Tb NA At"I COUMXTI DRAW.AT I 141 AWSA Mo <br /> /✓!✓ f�7�� <br /> FIOT/VIN 101—t.MMM SoW 'h <br /> 1. NAMIS OF IW"$DR NOADI WAnlST TO OR 6014/DINO TW PROPERTY. L IOCATIOt1 O/1IOv!(SEN1AllE REPO LAI fYST 11J OR rROrO.fo <br /> T. OVTItNf Of TNw►IIOfIRTY.W~DMYNMONS Mp NORTH DIRECTbN. EXPANWH Of SEWAGE DISPOSAL SY/T1114.I I <br /> ]- tWA"WNM OVfIM.S ANO LOCATION Of ALL EXMTNIO AND r* g"o S. LOCAM"Of WE1J.l W7fNN RAOIVS Or ONq HlU WWW F4 TV FT. <br /> WIfA CT1/11ES•WULIDi110 COVt11EtI AKAI VKH AS/Af10E.MVEWAY/.AND WAIXS. ON THE P11Ot'MTYOft AAJOS/INO MOOV".I <br /> r . <br /> . SSSS <br /> _: . :. .; SSSS.: '. .._. lI • <br /> ... < .........:. ...:.... ........ ..... , <br /> I <br /> I <br /> . . ..;. . ... . .. � .. .:. SSSS:. .. ... <br /> i <br /> ... .... ....... <br /> OQAR"A841 INE ONLY I <br /> A1yhAtW.A.wt.r v D.1. 2- N� I <br /> flr..A sr/ M_ D.t. .w..ro.t firD.1. <br /> I <br /> L A.wnrMr I <br /> ACCOU1ItING ONLY: AIOI ►ACI I <br /> ►f COMO IEE A00 AMOUNT RSfNIf E9 CNSCIVICASH owe Y WE t'I/MtItIStliViGE KlUSSI rlUrotf�t tNVOteI <br /> p .off l l t - - I-0 2- -2-_— _ � - _ <br /> fry <br /> Pva.HOAMI 90Y.•ElMfo.M(1191) i <br /> 10'd LMMM.092,T 01 WOdA Wd9S:LO L66 T-0Z-60 <br />