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Site Address: 16927 Brandt Way, Lodi CA 95240 <br />Date: 9/22/2021 <br />PHOTO # 1 New Well. Well Loci. Well grouted from 100 ft using 10.3 sand cement. <br />B..v-]o.o�ly couvry eNwR .L rn De...RrWKE. <br />��N_ON-REPUNOABLE P RMIT <br />I.]o. Anowss• <br />�o.....R N.r. Y.! <br />OwNeR AOORead' _ <br />cPNrR.�roR _ � <br />CONrR�croR AOORess <br />PERMIT <br />1 En•TN.se�roN AYeNue-BrOcuroN ew eelee -•S]2 (1e•)�ee-sn2o <br />_ Rc.0 BtLs ��No Ue• A.wlew+loN f <br />PNPNe civ-Z/9-�/O <br />_ GiYIB�.r•IZa. <br />PNave 33 � <br />w.Pve 3 7' �i7 <br />Nuresw ��/�-t Exvvuiwrr ogre � 7'� <br />C P �C n Buscowrrr�croRlCOraltirnNr <br />OOMeerre W-1: BAMPLNIO: O OenerSl MIMrf VCOIIIOrm Becterle (4301) p OWromoehxxoproPBr]e (4382) p Arsanlc 0303) <br />INreNeep U•s Om••tlPlPnvsla O Irnp.11orvbnwllOrei n Ineu•In•I O NIf1•r OUN11Y MonxMPO U 9011 SnnrpxnSfCh•rscterlrslbn <br />o Ppw��w�m s� rem _ s <br />TVPe O. WORT[ UfW WP IIQ Replace Wtl n W11 A14r•UaNModlnulbn . O OI]w/ <br />❑ MorMorinfl Wcp(n) �f Mwell• O SoU Bonns(•) °r °^tl'x• o Oeeler3.nirwl °r b.ro. - <br />O Oul-0fSennoe Wetl C] ODI-GJf-BaMee VM.x Rerrwv� O Gox•-ConnaclbM R.pxlr <br />rllllnp MNhod�Mud Rdary O Ah Rd1ry ❑ AUpar O Gable Tod ❑PUN] PP1M O 0lhyer- <br />ePesee Wfll D•PU.� to n ErG...xon �_ In tllert.eb]r O C)pen Bdlam y'3r.w1 PwWOrwval 91ie M aleme]er <br />O CdMuelor Cs•Irq In dsmeler COMudor Cesbq DeP/h n <br />W11 Cs•Inp rOimr•t•r� In TMexrx••/O•Ig1fA8TM Sch•d 12-1 <br />.a�We•BC U stwUN•s s 1 n 011]er <br />oro.re M.1 , ofPfh /ao n o Nsel cam•nl fw a efys+o yr ..1r.r1 �e ne cemvrn /O. � .er me.� 0.1 wale <br />O Bef]lonllf (20%6d1U•) O pPfer _ _-. __'__.. �___.�-.... ...�...�� <br />HCRGCY CGRTPY THAT 1 HAVE PREPARCD TN10 A(PP(.IQATION-AI'IO. TNAi ,,T MY�UI ! L ENBE 18 <br />OAOUIN COUNTY OROINAHG ETM.EBTA_ LAWB, ANO RULee A RCOULATIONB. 1 AL <br />CURRGHT ANO ACTIVE WITH CACIIORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSATION LAW B. '� <br />MINI UM 4 HOlJ7t ADVANCE NOTICE REQU1REO FOR INSPECTIONS -PLEA 3E CALL (209) 96]-7697 <br />woveP <br />17-Z-� <br />Record ID: WP0042565 <br />1 <br />-z a 42-- e-A2s <br />AZ <br />t--' -- DC PARTMENT Use ONLY <br />o.w empnYee,.or • ,/J,���r <br />By Del• O SPECIAL WBII Perm(t Q�+� <br />❑ WAIVER R ... 1—d VZ�4 <br />can.wvl.a <br />Francisco Garcia Ruiz, Environmental Health Specialist Trainee Page 1 of 2 <br />