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Site Address: 6610 E Collier Rd, Acampo CA 95220 <br />Date: 6/29/2020 <br />PHOTO # 1 Well Loa. New Well Grout. Seal set at 200 ft. <br />WELVPUMP YCR•�•• • C <br />ARTUENr /a88EASrHAZELTONAVENU J J _ <br />�A 96 OS -R232 (1p81 SRA -J42 <br />__ WWW.SIgOV.O - YEAF F <br />J� <br />�� <br />A CfTY/DP <br />I��Z <br />APN W S a�S_Z_PARCEL SIZE �� LAND U8E APPLICATION b --—`.__-_ <br />- <br />t'HONez4/r__� <br />'�/J <br />-2-1 <br />r <br />.sy <br />yS .._ <-- /✓l <br />I CITYIBTATE/ZIP_ <br />/l r, C <br />---•_—� <br />�� <br />3g-�=i-_.-�i2tr PHDNe y?_�� -� /T�� <br />�... ham'^ .-.rte✓ <br />j <br />Plhar NUIaaEw Z%21 2Or+ <br />E %PIwAT10N <br />__ <br />LbAre �-•7 ? <br />lJNT' <br />O $UOCOwIRACTOR/COwAVLTANT � <br />'! . <br />r 7 / / [S �- -_-G �.q �r <br />_-TOR <br />r� R'T r:rer7a (n J91) ibromoGhbrOprOPane (4392) (7 Arxarnc (g3D3) A �9 <br />// •� ,� C�• �`h"� L��/ 1 <br />!1 / LJ Industral ❑ Waler DuaMly MonAtMnD ❑ Soll Se-------�V� / ,� $ /- l - ! .•( <br />1 mPlinglGharacteriza r <br />werwr SYararn N me -- caA Y Name a' PMn� Kvnew ,n- <br />D Well V �jA•�,.q <br />AtteralronnyedAlcalwn D Olhx <br />� �? -IG5 - lr <br />%r •�i i- <br />D Oul-Or_S U Geofecttn Mai � N7Y <br />{jay vice Well Renewal O Cress-COnnRdlon R.palr OEP•�~TAt. <br />wR U PurnP R pair`-.__ ❑Ram. VVe11 Caalny__- rMENT <br />r <br />I tl `� _5--`5..,+ih�/T 1/ <br />rBer p. Cable Tool D Puen point U 01her <br />in <br />dle 1., O Open awl-JQ-Caravel Peek/Gravel SizeG7_ <br />--�j.�---�. <br />ale. l cone for Caalnp D"It, In diameter <br />rM sa.ed �� fl <br />D Steel <br />"LU •� - 2_i �] - -(�.Q A� <br />-_ PlsaAc (, as St 1 n Olner <br />nt (Bi Ib bag/S- s0 ge/ $Ia1nwater) _2 r ..d CementQ ---- -- -- <br />--1 �_.__,car lr mr./l Bal walrr <br />2-Z f 'L� S• �j, �a /- <br />/ Ret. --.t / ALtelera for (name) <br />h fl L n fn A T y R <br />P 5 .t II !. <br />RULES ANO <br />�rREGULATIONS_ 1 ALSO CERTIFY THgi <br />'tiACTOR3 -REQUIRED <br />MY LICENSE IS <br />STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br />tREQU1REO <br />/ <br />FOR INSPECTIONS -PLEASE CALL <br />(209) 953-7697 <br />L TYLE (JGL//�-d/F-• <br />M ENT US <br />Date <br />Date U SPECIAL Well Permit <br />Jate U WAIVER Received <br />Ialb Consfn.cfed Wall Depth _, ft <br />JVF�NAMP, L• <br />Sh--if Lam - <br />3S P 3RD- rLRj <br />-1xti>t% <br />5-2 -E- � s- <br />3 <br />Record ID: WP0040866 <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />