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Site Address: 22584 Dustin Rd, Acampo CA 95220 <br />Date: 6/3/2021 <br />PHOTO # 1 Well Log. New Well Grouted from 200 ft using 10.3 sand cement. <br />S. <br />NI sw�o.acwNrvEw.oe.en Ha PERMIT <br />JC NON-REFUNO.RLE P -W Der,ererNr 'U"E, HAM-�NAv[wx.S,Dcirtcw CAJ5M4Z12(MI.ML3.N <br />Jae A—. 7 7 CF�j ��W�Or ehd EXPIRESIYEARFRDY DgTE 16]UED <br />Ci ce«estierAT i�Jar-`n�x.� ' °%� <br />M cm m <br />tr OMNee N. ee F/��.J 7.OCA-��'l�--vueCu site d L—UMAnuC. <br />DwNe.AD«[.s ��rNi• PbNe y�r—=6--3 <br />C -TA -De Aobrt /dxe-7d <br />C s�«R„D-oM Dia, .from ,4,,A cN n,.Trm. lr/ra <br />Su.DaN-A,eroelCONg1gT,N, ADwee. vwee ZYl 2.a YT <br />LK[.ee Esc-sT our a DUe ann..ieme <br />$ L1Y°°v,Rn: 001ne1 NueeeR 3777(+'l <br />uwD ow,<A <br />L DoNDM WCIL S.MYIOIRN 11 9uBCDNrA,ciMICONeyTANT <br />F <br />2-V.§c JVD«rie. ~--���ra-C;!=RaaeRa(4391) (Dj <br />D Pups n'Prl"eb ❑ Irrg.RUNp„—�-� � ( �DPena (4392) n Arae 1 (4393) <br />��� erawy MONbrYp osr»I semDrrgrcn.reaeriz,nDa <br />T dlyoerw.N, <br />(I �� NeW Nke R <br />I' Pdamrpar NYe O Wee Aee elronAleancaam <br />ouar <br />a -OI . <br />O r ft. earl OSoll Bgbyp) eae - aGeaeav <br />latir New O Pu Re esemea C AAro RSa°DeY'Abe RenewM ❑ . d eame. <br />Cr«°CDrvleaan Repak <br />-�_ O Ralee Wee C, <br />HMrp MMhgf DMhy J-2 O R Rol a � TDd ❑ Pu.h PoMI ❑ ONer <br />ropoeeE Weg <br />O CaMuZ C2— b E n ebnebr 0 Open Rogan �GrevM P-1. see <br />Weu CMme D.—,., I.^Mar Caau C.",Dean n awRelar <br />Groa <br />DeDN��a D N.M C, y,ys. STI SNeI tl Pbir.c O Srembaa Steel O C4her <br />O BeNonge(20%sorts) OOIMr j}SMq Cement /Vi3 <br />a—Pbc.rneM elMrwe <br />Record ID: WP0042003 <br />L/ z- z s • Gn�r <br />2-36 <br />�yi•-Gx./l� L <br />sd�.G <br />-2-7q�zSc� <br />( HEREBy -. Suenere'DbD ryrblrro ❑ OIMr "`°�" U CnrhM Ru O St ply <br />JOAOUR! C Fe THAI I HAVE F%FAR6D�.iryp-gppyd�_ _ WmD set___ n—slsnD �+ <br />DINANCES, STATE LAWS, A T—T-Na --' "g1A2b-level <br />CURRENT AND ACTIVE AND RULES AND REGULATIONS. Sp��ERTIFv° TM� <br />WITH THE CALIFORNIA CONTRACTORS STATE LICENSE CARD AND TIq 1 qM IN COMP <br />WORKERS <br />CO UPENSATION LA WS, y <br />MY REQUIREDANC LICE <br />SpNeo �„` 4 % UR ADVANCE NOTICE REQUIRED FOR INSPECTIONS •PLEASE CALL (208) 953M769WITH ALL <br />rme_Q(,yA,xz. <br />-L� 2 - - - - <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 1 of 3 <br />