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crate I <br />Date <br />Date <br />ft <br />iI i MILINKIIIIIIIM1111 <br />al , ''''''ZIM/11111111 IIIV,WIE;n4111 <br />i ISMONIA11111111111111111•511111111111• <br />11111 11111/1111111111111;Mill 1 I <br />PAIIIINIIIIIIIIIMINIIIIIIPM <br />1111 N1111111 rill <br />AIMOMIMMOMMIHMM <br />MIMI <br />P.T, ill mmunimmit roma 1111•1101111101isi"liiil <br />IIIMIIMIIIIEWII R1111111114111111111E111_ <br />1111101 I Ell ill II Ibl ill A I <br />1 <br />raimram inummumnuom <br />IMIMMIIIIIIIIIIIIMS <br />1111 <br />nummims. 1- isi I , <br />• 111111MIMPUMMI <br />1111MLIIIMINIIIIIIIIIIIIIMATI <br />Itadiff,TITTITTIMMINIIINVOMI <br />=7117. <br />IMPIVOINiiilialiall <br />I II a <br />MN Ell - , <br />() il A . N.EJ.,11 3IT Al E AI T ULEI C11 L :f #4 <br />NacEiVED <br />6 Zt.,'iJ <br />UTN C.G1.3NTY <br />NMENTAL <br />EPARTMENT <br />• -(7 6OfQj Ama arvIveeM74 <br />SPEcuu. !Wen Permit <br />I/Irani/az Recanted <br />aele CoASITurind Well Depth <br />Appia' z'fon Acceptell By <br />amit Inspection By <br />Pump Inspection By <br />En3 Basing Inspection By <br />COMMENTS <br />lES WV9E:ll 6l06 'EA 'inr m!I 1)"!0 ;1 <br />WELL/PUMP PERMIT <br />Skti JOAQUIN COUNIY Eutnnotimotrat HEALTRDEP.ast-orerr 1868 EasTHoiriN AvaNue-STorxront CA 93.135 - RIM) 4S8-3420 <br />NON-REFUNDAsr F PERAET CALL (209) 9S3-7697 roRiNsPEC-norgs EXPIRES I YO1R FROM DATE ISSUED <br />Joadultss 4898 Livc Oak Rd cfraraLcidi 95240 <br />0,.,smE, 99 Frontage PtiN ...fm.i.scza if, stk. us. Ap....-...-4 <br />ar.,.,.EvAtIE Joe Gotelli & Sanq F},,,,,. 209-931-2740 <br />amrs,zApo 9189'N Ashley in ciStockton CA 95217 <br />CCM-TRACTOR Purviance Drillers, Inc pifniz 209 -887-3554 <br />CaNTRAcToRAnup.cc =PO Box 64 Linden, CA. 95236 <br />SuVcunrr-aAa'rarx ?NOM <br />i SUBCOMTRACTOR Amass. Cirt1Sumla, <br />377923 7/31/19 License 14 C-57 CI O-SI a D-a9 CI Other N111111E32 ExplexamlIkrz <br />Clata_,..,-nat_qa_LSA. C General rdnerallCafforst Bacteria (4391)E: Drororriochka0PruPane (4392) a Arsenic (213g3) <br />ilmannsa USE 0 DornesEriPnvale C Ininationffigncullurat a Industrial 0 WaterCluty Monitoring D Soil SarnpringICitaractetration <br />, D PublicWater System <br />-. IttlilTszstframOmer: '.Valu-Syst==re Corn= brato at Wu= NarCtr <br />Typa0cWenn C NeralNell C Replacement Well G WNIAlteraart/Morfincution a O1tm- <br />r...4 Manitoring WeIl(S) tt a was c Sal Surintas) 74 °1 7a6''°' E GeOlcia1111M1 <br />ri Out-Or-Senfice Well C Out-Of-Senrice We Ran/al C C.n,Connettfan Repair <br />6 NeePump ft Furnp Reptarem,snt E Pump RenaIr C P2is-elNall Casing <br />I tarELL Comma unnon <br />lDrilnng Method D Mud Ratan" C AIrRolary 0 Auger 0 CahleTool .73 Push Paint D Geier <br />Proposed Well Depth It Emaration In diameter 0 Open RPM= C Gravel PaariGra eel Size in Cia-Tzeter <br /> <br />C ContuciurCesing in diameter / Condutnr C.:ing Depth It <br />Well Casing larneter in Tnickness/GaugelASTIVISched r Steel 0 Piasrc 0 SlavailisSleel 0 Other <br />1 <br />CroutSeal COeipaen111 twee czols scifi-A'do a ONeathetrDenera (3eTh bagr5-10 gat mates) 0 Send Cement sact tre.17 gal l'4-AF.: <br />iGroutPi._ ent Method ia Pumped 1:1 Fre.0 Fall D Omer a Retardant iFcceferalor 4ciarre) <br />IPMEHLAL ins-teed By CI Darer C Pump Ccrntractor 13 Other <br />C Concrete Pedestal CDItnension Width It Leop in 7] CrnistyBax 0 Steve Pipe <br />i Puts> SubmersitleD Turbine 3 Other HP Pump Set n Stand:Mg WaterLavel n <br />I HEREBY CERTIFY THAT 1 HAVE PREPARED THIS A PPLICKDDN AND tith IPE WORK WILL HE CONE IN ACCORDANCE WITH SAN <br />JOAQUIN COUNTY ORDINANCES, STATE LAWS. AND RULES AND REGULATIONS- I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRSUT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT i AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSAR • VUS. <br /> <br />24* O" VANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 /A „cor p or ate Se cr etarai, <br />PE SC F Received I Cher.idfl 1 Amount <br />C=h Remitted <br /> <br />Semite. Rectueste, I <br />PeranW <br />7 /9 W )0(MC7(0 <br />Invcite# - - Well IDg <br /> <br />lotymrvip- <br /> <br />esct.ns mine <br /> <br />c.d <br />t19£L8960Z oui SJOflIJ eouepund BC9:01.61.61.1nr urrnviii