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AUG.21.2003 3t13PM TREADWELL & ROLLO NO.087 P.5 t r WELL/PUMP PERMIT ' 9At+JOAQURt COUrM XW WtrM09TAL IIsAt rn DWA)IONLnT 304 F WUt AVE 9'7L-SMOC"CA 95M-(709)461-3470 NOR'-RF.muADLzPExHirr D 0597 FOR PPCn a EXPUM Y Yx"Mom DATE IBM= I JOBAMWM YoN S-,%-MJ 4AP, Boo �7. o uc rr.� F(2slcy__---g553orF -rrl C7toaSTRIlm 556F- k$oVF- (( APN Z0?-t7AQZ1 PARtsLStDt A-moi aGerd Own RNA" fit P-r-z rt7Enr71 �.P, CY1GiK P.j S,�A ��"O('E�' Plsorlr $SB�'.�S7�uz3 OWMIRAPDRM 55510 1AnRCHp❑5E P91Vf- SdITE 2po crv19PAtirLr SAA/ D1E.G0. Crd_ 92.12./ Coeta .t� � arBrt.4 .a R aet alta J��a�eoa.� SG��sdtll j PAOMt_ !o_-g7W�'9�. Cutliw47'itA1 T ODOM.&,«�Ar o ts�v�4 d-( f�r1+ 57- 3 e., c*�rrrb�ArWrlr_�I�rCia�n, cA 94612 +� stmcotrmcroa xa.+ • r yee.IC* 8 bL _1 —Yid-.Ls� Stns: mTRAcroaAlwRiss t,-, Q *r- AAV- CITv/BrATsrru ' 3 Iatayse CI asp q C41 13D.09 ❑othn NtAfOLR � ,ton DATs D o GZ0GVAt'51lCALVMRAAT10N4 Cadrdlnezu X-- Y Tapms*_ Rupe SeeRM INT>g tum Usx ❑Domaddhivale q C3 hKt tonin 13 Wmr Qtality marat ittp ig w Z O Public raar�yRrJa_ tf dl,r.!aysn= a Tyn or Wow[ CI Nene Woll ri Rcpltacemu*Well Cl Win AlnratiaJModiScstion ❑Tca Role q Odom El M"ftw4 wants) aw tv or-& ❑Soil Uwir ls) nsC it--rofthw4 jp �(y o'e►Qw►atss JJ 0 Wen DMItrKsm o Out-W-Sarvia Won Cl Otlt W4ay1w We'll RallarI C.A s+ s�rr,7 taw. Q ❑ ❑ Iamwn: Oair Q Qms.Cotet.6m a frit.(tom � WIitL CON4'rrenCK10N (Z er ;�w3 DAHAy Mailbd q)oPd Antnv 0 Atr Rotary E AUM ❑Cabla Too] O Penh Point N odor L2- C STC YG� PrepoW Well Depth ft Elewvawn_ in diunaeT f]Open 116tim U Gravel Pact/Graval Sim in dismM p q Cw+dgator Lis og rA ditrleCer / Coodprsor CuM Depot___h C WellCaslor Dime"—In fiicl GmtrdASTM.Schad ❑Steel ElPlatde ❑SgmbsmSud nOther Gi sut Seal Depth (1: CI Not Cat Aw f'5,1 1b Mg/S-10 got waw) Cl Sold Omaal soak oft/7 Sol rKcr 7z, q 8=loallc P%FAids) ❑Manch-u=Spec%solid$_% Ntms ❑Spats on File M Spero SolrobW C t r2at PI$u*mt Katbed ❑ O yno F$il Cl Other M Aetoditta/AwelftWoe(eam) PRPILWAL I s�Foad ft *111la ❑Pymp Comma= 13 Ogler. QCowreoePeinhtl Dlnsnslow Width ft Len R Tbick in ❑CWM Has 1:354" ?u w D subateraiyle 0 Turbine D Omr _ IV__ Poop gat ft Sk=C1PS WaW LcwJ A WLmDwntucnoN A Open Bottom ❑Ouval P" 13 Vnetatd ❑MET Wall Diamamr_____11 Tool Dsplb _ft Dapth o Water_ Q R tlafutd m bo ParSorwd Rem A m R 8ealor m-bef I 14 Neat CaePeat(9416 bar/J-10 ret rmrar) ❑Sand Carlwittate'/7 tai vials Q Baeopite Pd ksa S 0Dawri;iteCA%o0i4s)• gMastdkinretSpea%solids�% Name ❑"oaFile 13Speababeoiued 1'fetettltaentl1lletkad ❑Pmped P(FfoaFall ClOdwr q ST21M with N[whroom Cap 9 below rsade 13 Oompie►e to Hdofte Stsrstoo Pad i 1104MY CXJnj$y THAT I HAV$PREPARED THM APPLICATION&ND THAT THC WORK W"HT.OONI 11'1 ACCORDANCE WrM SAN JOAQWN COUNTY MOV411CIA STATE LAWS,AM 1aIl= AND REGULATION& 1 ALSO CMIVY THAT MY"0111M UMM 0 CURRENT AND ACTIVE WPIE THE CAL13tORMA CONTRACTORS STATIt UCEN31 BOARD AND THAT I AM IN COMPLIANCE,WFM ALL WORIQM COMPRNSATION LAR%. M 24 HOUR ADVANCE NOTTCE REQ UIKED FOR INSPECTIONS srct� TMA IF. ieL fpS'/S� DA O i H I l a N u oe� R //�'�n �/�{ y.,�P,, DEPARTMENT USE ONLY 7 r Application Accepted By Li lit^`+ V 5(l,N�+'l�th' Daae t�-- 011- of Asn �. Emplo"m I[)N . Grout Inspection By_ Date ❑ SPECIAL Well Permli Pump Inspection By �J Date_ ❑ WAIVER Received Desteucuon inspection 3y / Date 0 Constructed Well Depth It COMMF-NTS �O - PE SC. Amount Chcc ReceivedDate -PCIU e p Godes Info Remitted Cash By Servlee rm[ oast R invokWell[Dtl 72 X 5 0 1- z EHD 43-02-t50G O'7SSG k c ra s�,,vf 517/2002 - -7 � MASTEII WAYER WEL P Ml"