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WEU-J!"UMP PERMIT <br /> SAI4J0Af4UVI Cowfi,Y Er-rvigow-41214TAL HEALTH 0EFA%n)4rjr CA 95206-(209)4683420 <br /> NON-REFUNDABLE PERINfS `w '2 CALL"209 953.7$91 po.R lNaPECTtpNg <br /> EXPIRES i YEAR <br /> PARC SIM15A I-A'joLIsqAPVUCA'TM#L <br /> OWNER INAtAfi N�t\-7 �APN r -rr <br /> D-q) <br /> omizot <br /> CONMACTOR 4AU_S!2d4l� <br /> COWAAOTmADDAguc <br /> PHONP— <br /> CirfISTmiZip <br /> DOM90TWWOO.' A10UNG: General Mine fal/Callforrij Elaj;taja(4391)1 Diblomrohlo(opropan9(4392). At!3en:14(4393) <br /> 4601ne foww(� <br /> ri P Jbfi;Water <br /> jraq2*M OP-Im-wWall i'l RNtplacerneni:Well <br /> -1 wmlodro well(s) I o".jelix r-,Soil Imckaw <br /> ej wof in Out-Of.&aivirA WO Nbr4wvf Orolis-Connec Won rigpejr <br /> lOrIlling Mo(hod n Mw Rotary f"Air Rai", :`Ay2tr Cabla Tool I Push Point 1.j of*t M 2 <br /> PfOpOeed Wall In oiAMCIAr L)I)OD130tiorn, ",Gram PSWa-v I Si 11 ", <br /> ENVIRONIkIENTAL IlEAU'll <br /> Well Cuffig <br /> Grout Sobt DepthIft :42at Carneril.(-ad unto (land Cement_ -ex r*/7 941w,PA RIA1 E N't" <br /> 0r7r,AlordIts(2Q%goEdz) <br /> Pun Ld il Fme FAI "'Cit-or (nd,-) ��--.__- I) <br /> PDQ SSfi� In%14114day 0e, Pump Contmelor <br /> doolal r!Diianaiolw; <br /> 'Ei <br /> I HEREBY CERTIFY T4AT I HAVE PR9PAAr;0 THIg AFFLICATION AND THAT'Mi WORK WILL.BE DONE IN ACCOIRDAWCE WITH SAN <br /> JOAQUN C Ty ORDINANCES, STATE LAW3,AND RULES AND REGULATION5. I ALSO CERTIFY THAT MY IRC-QUIRv-0 LJ05NSE is <br /> CURN 501) ACTNE WfrHfTHF CALIFORNIA CONTRACTORS STATE UCE4&E SOARD AND T-dAT I AM IN COMPLIANCE WITH ALL <br /> WORK= CO PENSATION <br /> )Okv$al <br /> 1, 24 U VANCE NOT CE RROUIRED F76—R1 M�BPP�01C�IQS-PLCASF CALL(209 -169e <br /> SIDnVA __ Tn-'x ,l <br /> -."ptit <br /> i-t- <br /> 94� <br /> I I L I 01Q <br /> 1 11 T <br /> F-- <br /> DErA A RTMENT USE 0 N L Y <br /> Application Accepted By 41KN—Iwd' 4,�, L Date -- -I & _ Area Employee IDIA4�-W <br /> Grout Inspection By Date t C TTSell Permit <br /> j WAIVER Received <br /> Pump Inspection By Date <br /> Soil Boring Inspection By Date Constructed Well Depth ft <br /> COMMENTS 6it 1,/ W-14 if I ',J <br /> —Wig, A <br /> PE SIC Received- Check Amount Date Permit/ Invoice# Well ID# <br /> CoCI&S Info By- - Cash Remitted Service Request# <br /> 7 <br /> EfiD43A06 6101116 -75-9 7 W1 WELL]PUMP PERMIT <br />