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Site Address: 14000 E Collier Rd, Acampo CA 95220 <br />Date: 5/5/2021 <br />PHOTO # 1 New Well. Well Lou. Grouted from 100 ft usinq 10.3 sand cement. <br />ADW41bn Accepted By DWgl a <br />ANM Envky.. IDI <br />Grad IrBY Oek "t. SPECIALWBNPer.k <br />Pump lngv-spxaon DY D II WAVER Received <br />IME -U, l cibn BY OpN COIHIrMckd Wvll WINK <br />COMMENTS ��IA� _V. —�� _ /l �� R <br />PE INC Rvc ChxCN AN—DIM <br />Acm <br />R..Iry 9.ry p R uMl1 Invakv • vl.ry IDI <br />q l 21 <br />-'� Z 0 11 <br />L ( <br />D n Nlw.l. 'L L <br />wEunwrxwR <br />7_S9-t."-3-'—/cJ <br />L 7�. 2_0p2 S'�fi,�/j <br />Gtis6:1 <br />'L6'3 <br />sQ,c,�- Gtzit <br />Record ID: WP0041961 <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />WELL/PUMP PERMIT <br />S.NJDAOMNCOunry ENvxONNe—H—DEveerMENi IBES EAar HAtlLION AVENUE-STtx.tow CA BS30B 1p72 ltae)111-3110 <br />Zo- Z<'" <br />NON-REFUNDABLE PERMIT wNNwwaJgov.Drefehd EXPIRES'I YEAR FROM DATE ISSUED <br />z <br />`" 7 � <br />J.. Aauvw. /B!� �' CITY. C. IYI <br />-. y0 <br />CRoa. S— zu TTS, E<.J �Z(0 Pua:E 3 L.NBUIMAMLI <br />p� <br />_APV .30� -A <br />Gu�GI N��e <br />J a may/ <br />O—R NAME P— YS6- Za 3/ <br />Q <br />%2` a/. y <br />OvxERAm— S�Pr�' CDYIB,A,NLP <br />GS- <br />cON,R.DroR f" s tl ' PNDNE 3Y-Y7a,•.5 <br />6%- 7 `Y- <br />CON,RAeIORAOORes. t7 a DRYB,ATFRM <br />./p <br />suecolmuc,ol.ICONNATANr _AC tR� �Mf'i � PHwE <br />,J <br />SUBOWiRACTORICORIII N,ADDRESS CITY/afA ells <br />, <br />L,L.7 <br />U ct+ <br />LICENCE ?l C -n o — O omn 7 <br />NMMEA3 7,i7T E.wM,KW DA,E G-ZJ <br />BALWO PAPTr. I OWNeR LMCTDR I I BUe00NTR.YCTDNCpaµTANr <br />,/ <br />l Z-' g ` A /Z c -1..J <br />��/ //1!/ <br />DOMESTN:WELLSA ID; 1l General M,—VCDlif-8,H,RRN(4391),I Dlbromorhbroprpperla(4392) 1! Ari -(4393) <br />INTENDED USE DmnealKlPRvele DIMpMbNAplw 1 Dlrtlu.tdel OKblerQuelnY Monikrinp O SMISempnnplCh.Ieclene.lbn <br />cmwr OnuN <br />T mewwOml �/ <br />N - Mf A[LReq.LertMRI YAH DNbE AAerMYNJMOddloilOn ❑OryMT <br />❑ MonnoMp vJeP(.)_ 1 d wOU1 U Soa BIr V" .M W.N. O GeMeLLIW W • MSM. <br />1 <br />0 DP-0vke WeB D Ou OlServke NVetl R.newtl D Goss-Cawclnm RBOW <br />U New— U P R acemeM U. <br />cls- // <br />WEU CONSixucrroN <br />DMItn9 M.Th. W -C R.W 0 AY R.MIy 0 Aup'erl O C"TOM L' Push PMM G OVMr <br />Pr 11d WMI Dep#,:3 � D 6rravvUon M dMRMtx o Open BelRxn i'FGrrvM PxAlGravN SUe N Okmekr <br />(_�] / <br />�" �` <br />D CDroud/a C.Mrp-_ k MIxMk, , COIM.cIOr C.HA91kNA B <br />/ B 6— <br />Wsll C..IRp 011me1er.7>_ h THMUMSSIG.IgNA$TM STIIeO� Dla.lkCS <br />mD <br />GiSul DPR, /00 0 O N.l Cmw k DOS IO pL ~ <br />p <br />'�IiP <br />."m a- "RM) 10— <br />ML <br />0-1 PMC -1 M.U.,AQP=d 0 F.Re1W I A¢eWWn (.—I <br />rQ IR.wl.d RY Dnb, D Prx9 DonYxAttD Oiler <br />0 ConrnM P m.W QDlm.nvlwH' VMIh n l Igm IT Thl4 I hRsry BR D a P a <br />?3 v <br />2- 3 a-..• 2 35'(-k tri"I <br />.QSMbnNMMeDT.— OOBMr <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIN APPLICATION AND THAT THE WORN MILL BE DONE IN ACCORDANCE WITH BAN <br />JOADUrN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE ..AN. AND THAT I AM IN CDMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAMMN. <br />W <br />111 <br />23 6— <br />C <br />MINI%MMI��jMM' 4 HO R ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL (2D9) 953-7697 <br />SIDNEp /�S n- /�"tle% DATE _y iJ1 " <br />S <br />ADW41bn Accepted By DWgl a <br />ANM Envky.. IDI <br />Grad IrBY Oek "t. SPECIALWBNPer.k <br />Pump lngv-spxaon DY D II WAVER Received <br />IME -U, l cibn BY OpN COIHIrMckd Wvll WINK <br />COMMENTS ��IA� _V. —�� _ /l �� R <br />PE INC Rvc ChxCN AN—DIM <br />Acm <br />R..Iry 9.ry p R uMl1 Invakv • vl.ry IDI <br />q l 21 <br />-'� Z 0 11 <br />L ( <br />D n Nlw.l. 'L L <br />wEunwrxwR <br />7_S9-t."-3-'—/cJ <br />L 7�. 2_0p2 S'�fi,�/j <br />Gtis6:1 <br />'L6'3 <br />sQ,c,�- Gtzit <br />Record ID: WP0041961 <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 2 <br />