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Site Address: 14000 E Collier Rd, Acampo CA 95220 Record ID: WP0041961 <br /> Date: 5/5/2021 <br /> PHOTO # 1 New Well. Well Log. Grouted from 100 ft using 10.3 sand cement. <br /> Vis. <br /> WELL/PUMP PERMIT /(/k ) w <br /> 9ANJDADMRCounrr ENWmxMFN,AL H—DEFAftiYENi I.fie EAST.—ION AVEMR-Stoc.iaN CA$0203 d13311n91...-3A]0 Za 2-<'- AI/ C� h, <br /> NON-REFUNDABLE PERMIT W W W,� py,0 Illltl EXPIRES'I YEAR FROM DATE ISSUED <br /> J..ADDRESS 1 {{� - (•1 y CRY2 G IYI 7-6- 3 7 <br /> CRO..S*PFEr t U 7-/C � El•J/ APN D Z.I V'! .30�P.RCFL SN:.`J_.I..rm U.F llmlullw. <br /> OwNERNAME P—YS6 <br /> CNA&.ADDRE.6 <br /> cDATR.CroR �-- s tl e PNDNe <br /> CON1RAClOR ADDnFe. D �� l7 emBIATFRw r -A+'ql.. <br /> SUeCDN'1RACTINIX .ULTANI _AC&'tl 6/0Z PHwE 745 L�O/O./p <br /> BUBcoNm.c`ro/aeorKw.T.Hr AOOIea C.YM.ens I Lc� -!-.7- <br /> LIC.N.e tGV U C81 D Don U OMer NA NR377 5' ' EMwuBONDA,E 6--20 <br /> B.—PARTr. °D— —CTDR a SUB—'TONCONSUITA /2 g" /i/7- <br /> OME <br /> DS,K WELL SAMPl91O:11 GeneralM'—VCWif-9eLYBru(4391)')DrolDmorhbroDrcp—(4392111 A--(4393) ��``// <br /> INTENDED USE DamBJPnv.1e OIn19elbr✓q(FILTrnur.l OIrq,Btrl.l OWMer WeINy M.NNNnP OSMI D.mpnWlChereplerR.lbn `/06` rxme <br /> _ °�vM Yom VrSlem 6 i�.(aG L <br /> T—Of WORK O New Wen ><ft.zNrMnl W!. D Wen AMerNi.nnAotlmwpon CI qmr cmwr rnm. <br /> a Monnahpl vJeP(.)_.oI wells D Soi Boivg(S) •w euvyu Cl Gede<Imbe1 .Newp. {7�{�(/�l/� <br /> O Or4-0(S[MG Wen D OMOiServke Wetl Renewel O Cro..Some[tion Repev 1 Fly <br /> U New °P R .mmeM ❑ R et U R.ne We.C <br /> WEu CON.TxucrroN /f/J C/ (/'_" <br /> ONIIIn9 Mvtllotl YCAAW RUWy U".0LRy DAD rr U CAMs Tod L'Push—A 0 finer <br /> PI—.dWNI DePV,:3�. E,,— - M danroler 0 Open Bollom QFC avN P�GrevN SITe__N D'ulrokr / <br /> U Coro /!•C"W—Lr,a Ne 1 CmlDCIor C.IIW Ikp:n n - <br /> W.II C..IRL 01.mele A IR D sM,R AS'PWIk D'm*—.Sb.N O OBMr <br /> Omur Sul De W+ /JCI n a Ne.l Cement ln4.n iMw"'D Pw-0 sem CE.IMm /V.7 „eE,nnn wl wkr �� LllZ <br /> n�rv.,mF lzou w1�) G olne, <br /> 0-PNcem.nl M.-Co P-r-[0 I'm FAIL 0 ONN °ReIW I Amekwkr(—I <br /> �le•wNd�ey on.er D wU a oue. <br /> 1(73- <br /> -.01-== L Z-! 1,1614 1 <br /> -F-n Lc�npn n TNa / <br /> CILL .�sw.DnHMeaT.— GCnnM HP. ... PwnSP P . �..w.,.,.,.__� - 2— <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION ANO THAT THE WORN WILL BE DONE IN ACCORDANCE WITH-M <br /> JOAOUIN COUIl TY ORDINANCES,STATE LAWS,AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACII✓E IN TN THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL -L3�—�Y s,• C !�r <br /> INORRERS COMPENSATION LAMB <br /> MINI�'A�4l NO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS-PLEASE CALL(209)963-7697 <br /> sIDNED �..�`S nneY/llli(.�'� <br /> DATE 4- <br /> 3rE-'Z/ 1`�� <br /> 2 74.Z 8� Sifv <br /> Gtis61 <br /> J —3 0 <br /> 3L ss <br /> RE sQ I�J 6fyr(i �> <br /> NT <br /> U DEP RTMENT USEONLY <br /> (/�y'�l/����� <br /> ApoBy DRA L/ � -L I /T <br /> ase Employee Em <br /> Gmul ImpBy O.k '"I I SPECIAL Well PB,RIN <br /> ..., .. <br /> Pump Imp— <br /> ecgon DY D.k II WAVER Received <br /> Son Bor.q In cibn DY DEN Cen.IrvcNe Wall Bvgn <br /> COMMENTS� FA� n L CvhC - _ N <br /> PE I k Rvc ChxhN Amwnl OEM Pvn,NV <br /> n �� 9vrvk.R II..I a Invakv• MhN IDI <br /> -21 <br /> 2 t p y <br /> L Lf 0 l <br /> L. <br /> H <br /> Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />