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r- - �1 <br />pp,`(I <br />REG <br />,.EALiH L <br />S�y,'l l ''DN Wd6S:c 9l01 '66 'any ;lull p;Al;3;u <br />WELLIPUMP PERMIT <br />SAI: JOAW N CMKW ENVMCNMENTAL REALTW 0FPARwuE.vr 1 Bim EAST HAffi.TOI AvovDE - STCCMCN CA 96205 - (209) 4631 u2o <br />N-NEFUNDABLE PERMIT CALL {209) 953-7697 FOR INSPEC'P.ONS EXPIRES 4 YEARFRom DATE Issui-D <br />ADD;r.ss crryrzpLindefi Ca 25236 <br />SS S7RREET '1111 3 RCI APN PatCt2St�tftto USEAPP.-CA71ON 1< <br />IERNALtE ('.RTA T.agr,.marcinn P,,..,209-62 -- <br />ER ADDRESS CMISTAWMP <br />C <br />TCh <br />Plurvian�ce Drillers, Inc_ <br />SS <br />ADDREP. a Tr ox 64 <br />prow 209-887-3554 <br />CMJSTAM97JP minden, CA 9523 <br />P WE <br />CToR Aomms CttvrSTAIIEMP <br />C-57 L. Cal _ D -W _ other N.. 3 7 79 2 3 e,.,o, DATE 7 131 / 17 <br />JECCRAPRICALINF'ORMAaCU- Coordinates X Y Townshlp_ Range Section_ <br />'_u1 molio us E ADattestifYhlvate _ Ini;aGcrJAgricvltural C Industrial '_ V ter QuaJity Mrxalor g h7Sod SampingfCham=e-tmllnn <br />i! P"c A*er Syslem <br />ildlf.aerr EmnQ.lear t � ucr a.crsm +m.cr ns .mom <br />_ —.1— - nepumEam m' -Yell 'J wen AnefaLCit mdj,=u fl ;- Other <br />tttcritormgvvef(s)Cot walls :'t Soil Bonng(s) a`ftvmos r Gewerhnleal eofbomw <br />_ Out-�,YSeuvice Weil ^ Cut-OfService Web Rermv-J r, Cress-Ccnnetlmn Repair <br />A New Pumo L Ptfrno RenImn" t r p,,,1,,, P-- <br />Crilling Ma!hod : Mud Rotary Air Rotary _ Au6er _ Cacle Too) , Push Point _ Oder <br />Proposed Weil Death n Excavation in diameter Open eouem C Gmwl PaulGravel Size in diamete <br />CDnduCDrCasing indiame!er f CondurorCasingDepth R <br />Well Casfrtg Diameter_ in ThidmasslGaugejASTM Sched C Steel _r Plastic C Stainless Steil C. Other - <br />Grout Seal Depth 11 ] Neat Cement (94111ba.;5-vagal eater) 7 Sand Cemml sack a9rf7gad erne <br />Ben1cnite (2C`-,sa4ds) 7CIher <br />Grout Placement Matl.od 1 Pumped r_ Free Fall C Other _ Retardant /Accelerator (acme) <br />Pjl)1 7AL Instatied By _ Oriler Ptfmp ContractorOther <br />Concrete Pedestal i-Dimenslons:Wdlh In Length n TrdCk in L; Christy Box L -S o Fipa <br />PuntP 4 SubmarhleL Ttudne a Other HP Pump Se! R SlandM Wa!erLevel R <br />1 HEREIRY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK KOLL BE CONE IN ACCORDANCE WITH SAN <br />JOAQL'IN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CAUFORNIA CONTRACTORS STATE LICENSE EOARD AND THAT t AM IN COMPLIANCE WITK ALL <br />NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 9P-7697 <br />T„ti Corporate Secretes <br />0 <br />0 <br />m <br />2016 <br />AL HEALTH <br />rn CES <br />P RTMENr( U E O LY <br />App...-"ionAcwptedB9� ( � Cale �� P.rea Empto.reelC1C61�-rb <br />Gmut Inspexon 9y _ Date�/��� AIV7 SPECIAL Well Penn$ <br />Funptrsnron9} <br />Dale v �____ W D WE.RReceived <br />Sari 9efing fnspecticn By. Date <br />` Cortstructed'dWell Depth_ -__-tt <br />COM RENTS <br />Codes Into 6 Cash f Remitted Dale I SarvlrrRequestY invoice# WonID4 <br />OL-4;70."gkZ]l(c SRUU76-57y I I wVnj)iAOgJj <br />E'd VL9EL2860Z <br />wf-Lipul-p PUtlYr <br />out sjajjua eouaitimd d50'. 6 6 ZO ZZ JeVV <br />