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. RUG-3-2007 10:06A FROM: 2098873574 TO:4640138 P.2 <br /> i <br /> WELL/PUMP PERMIT <br /> SAM JGAQVor COVKTT INVIRONMLNTAL II[ALTII DtrARTMQR 00 IL Mala 91rae,-STOCKTON CA 95201-4309)446-3410 <br /> NON-REFUNDABLE PER.MiT CALL 209 953-7697 Fox LNSPtiCi 1(1x5 EXPIRES 1 YEAR FROM DATE ISSUED <br /> o JUeA00",T 12601 N. ClementsRd. c,T,,,r Linden 95236 b <br /> ARAM /fC,AFN"�`��I�'l0 PAYCeLSIxG— :5'- _LA�oUxKArrLteArtnh/ — g <br /> OwNtRNAME Jon Smit (Smit Ranch) <br /> OWN ERADDR,a 12601 N. Clements Rd CrT,•mATuZIr Lindan�CA <br /> I <br /> Cu'".Lwoa Purviance Drillers, Inc r11DNt 209-887-3554 <br /> C(NITNAL70Y AUnAL.s P. 0. Box 64 CITrr$TATLMLi nden, CPQ 95236 <br /> SUBCONTRACTOR n/a pNDML <br /> SUICUNTRACTUR AODUM CtTY18TATVZ1r <br /> LIt:LNss MC-37 DC•61 13D-09 OOtho, NUM■La-3-219 2 ExTI1IAT10NDATt Q-9 _ <br /> C[oORArxIc.LlnrultalATtoN: CeortiLl■pa X Y_. Tawnblp_ Ran e_- Seedue <br /> lv I nocu L'AL •DOnklud?nveto O ImptiordW"Itmi D LldustriLL O Wucr Quallty MooiwnnC O Sull Sulnplily ICltumcicriuoal <br /> 0 Public Wow S1Y=01 _ _ <br /> Ifonv .earl D.— .tY INa. m< —..m..r — <br /> Tt rr Or WUY. 0 Now W<II O Rcplaeammt WaB O Wall Alw,".WMadiru<Yun O Blur <br /> 0 MOAIIOrinR W.il(r)_j or Welll OSOIIBQ'Lq(.) 11111d.p 0Gogechnic.1 ..ra.,.p <br /> 17 Ou-0rS4rvlco Well O Des-Or-Sorvlce Wall Renowsl O CrOu-COMICCI On Repair <br /> 0 Now Pump 30 ftmv Re 1■ccnn i O Pump R=k <br /> WLU CmsI Yl,nm� AA ` <br /> Drllll 11LIAd DMud iv <br /> ell KDWy ❑Air Revnry ❑Auyor Q Cbl,Tool O PY.h mini l]Ouur <br /> Propo.ed Wcll Dayd n f!Aw.uim - in d=wta O <br /> Opw Ekllortl O Gnv<I Ack/Gnvel Siu in dunuter <br /> o C--J—C-lM to(Uu=r r Conduce.Caa1.#Dopes n <br /> WUI Cuing ONVMtcr_In Thk%rMaJOLuydASTM&hod OSI..] O rlaMic O Stainiea Sucl O Oth.r <br /> Cruel Swl Depth a O Nat CanuM(S4!0 tM j/S-10 Cdr Yaty) O Sattd Ctimmi Lott.1T!7 Rai WYCT <br /> O Dcatomw C2D%sand.) D Meoul►O-w Spec%-IW$`K Nan. ❑SpAca w Pile O Spee Subniumed <br /> Grein Pla<auull Method O Pun O PIw PW 0 O,htt D Retard"I Aoecter■tor(.tune) <br /> r1 WAL InalaWd By O DnUtr O ruDtp CaoDacwr O Other n <br /> O Caaaralt PedW1I Dimogtbar:WWI O n Lealith n Thkk to 0 Chria Boa O Sw.,plLuz t <br /> ■Sabro-bk 0 TwbL e O OIhlf HP PUAIP Set n Srondin Watt,Lowl <br /> I HEREBY CYRTIFY THAT 1 HAVE PREPARED TIM APPLICATION AND THAT THL WORK WILL BE DONE IN ACCORDANCE WITH SA.N <br /> JOAQUIN COUNTY ORDINANCES,STATS LAWS,AND BLEs AND R&CULATIONB 1 ALSO CUTIFV THAT MY REQUIR4D LICINRt IS <br /> CVRRLNT AND ACTIvL WITH THE CALIFORNIA CONTRACTORS(TATE LICENSE BOARD AND THAT I AM IN COMPLIANCE!WITII ALL m <br /> WORKERS COMPEINSATION LAWS. <br /> IN1UN1 24 110198 ADVANCE NOTICE R V QUIRE OR NSPECTIONS f �j <br /> S�t:�lu TITLI �( V7 <br /> DnIC <br /> N <br /> AYMENT <br /> 11�ECEIVED <br /> FT I <br /> G 3 2007 <br /> i <br /> JOAQUIN COUNTY <br /> VIRONMENIAL <br /> TH DEPARTMENT <br /> DErARTMENT USE ONLY <br /> I <br /> Appli-des A.,q"By Due 3 U� Aro. EaWloyae IDN S� 4 <br /> y t <br /> Gloat Intpoction Do O SrECIAL Well Perm <br /> Pump Iupccdon D O WAIVER Retelved <br /> COTS D <br /> well [A <br /> rn .� <br /> �t. <br /> ed COMJ! —net PArtalU <br /> arM ". Dau [,rvl.v R Yea■ laruhs[ \VoU{De <br /> 8r VSO I VSD t) <br /> 010.Lq Una y <br /> /11r]nar YQl IUW led MR <br />