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ROSS'°N Wd�S:Z 6107 'll 'Upr omit pani;D;� <br />WELUPUMP PERMIT <br />SAN ,lonourn Cauury EwRnNyEvrAL HEALTm D EPARwE rr 1868 EasT hlam mtr AvcmuE-SmcKraN CA 9E2DS - (269) 468 -Un <br />NOX-REFUNDABLE PERIRT CALL 09 959-7697 FOR INSPEc-noNS EXPIRES 1 YEARFRom DATE IssuED <br />tosAnmqms 806 E Mariposa Rd crNmP/Stockton__95.2.15 <br />CR=sS7REr=1rCarpenter RD - O-Z�p s� "f 11u+oUSEAuoLsnnas' <br />oNNER NALlE Mahii Lothbir , 'UNV-1/ �--PHorm <br />c.a,AnoREss 4806 :°E Mariposa tamw,[- ,nrsrAmoFStockton CA 9521-5 <br />ICITITRA(7TOR -°urvianee Drillers, Inc p,,.209-887-3554 <br />CcrmiAcmR AoDRE§ PO Box 64 c,,,,fS.,A,jz�L i n d e n, CA 95236 <br />SUBC O WMAaMR <br />SL'8CCN7RAC?DR ADDRESS CrrvISTATFJrP <br />Lrco sE v C-57 ❑ cst tT ❑ o>hEr NUMBER 377923 UPRATMN DATE 7/31/19 <br />60&117 rc Wa-L SAMPtlrlZE P, General wrtemucofiform 9aetPria (4391) � Obi rarnochlompropane (4392) : Arsenic (4393) <br />lm'Emn[D USE ❑ DamesfeciPrrvate C 1aigatianlAgvieulturai E Indusural C Water Quality M9r6rarisg O Sal SampfinglChmacler lice <br />0 PUKcWelerS�lem <br />a Si[ermm Ram c"tr, W4ers4rrL rLzre cuxwttr=cr Pnnnn N'muiu <br />I_ 'o, - <br />TYPEOFWOW ❑ Nen Wed C ReplanernentVM1 C Well AlterattaNMadifieatian O Other <br />D Monitoring We➢(s) #afvMIS G SoB 8oringis) =QTt=I093 C Geotechnical <br />c Out-OFSpmi=! Well n pat 4fSavcc Wel Renaral O Goss-Cormeuian Repair <br />=crbuRmis <br />nlling Method D Mud Rotary G Air Rataary 0 Auger 0 Cable Taol -1 Push Paint P. Oster <br />reposed Well Depth R Excavation in diameter = Open Bottom G Gravel PactJGrave] S"¢.e <br />0 Conductor Caging in drameier ! Conductor Casing Depth R <br />WeJI Casing Diameter_ in _RiClMcs/Gauge/ASTM SChPd _ Sleei 7 Praslia :� StaBrless Sleet O Other <br />^Grout Seal Depth Y D Neat Cement (94 16 6aos-90 gal rralPt) Zi Sand CemenL sad; rnxa < <br />` e Bentonite =% Sous) :1 other <br />R EPigampritMetlmd i Pumped D Fine Fall 0 Olher _ u Retardant IAccelerator (aame) <br />Installed By D Driller 7 Pump Conlradar D OIher <br />eConcrete Pedestal COlmenstons7.Wdrh "t Le-nolh ft Thick in -1Cnrt51vE= aRtatre <br />m <br />D <br />c <br />c <br />m <br />m <br />�� SubrtneII Turbine ]Other HP Pump S ft SlanrDn9 Wafer fl ill <br />Temay FY THAT 1 HAVE PRF-PARm THIS APPLICATION AND T THE WORK vnLL HE DONE ltd AcccmAtl <br />CMGUIN COUNTY ORIDNANCES, 51'ATc LAWS. AtdD RULES ANO i:EGUL0.TION5_ 1 ALSO CEA171;-1f THAT MY REQUIRED UC E <br />CURRENT AND ACTTW NRTH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND TlgAT I AIN IN COMPI1ANCE V�Il17i A <br />�0; <br />WORKERS COMPENSATION LAW _ i�� Mf1V1 1W 214 H A CE N07ICE REQUIRED FOR INSPECTIONS - PLEASE CALL (209) 953-7697 <br />sl T,,�orporate Secretar&_,, <br />Pranp Inmpacfrdn ey Date 7 UUAwER Received <br />Soil Boring Inspeclion By Dam Constructed Well Depth it <br />COMMENTS <br />WN <br />Z'd VZ9EZ8860Z OUB Sa811i.lQ e3Ue1Alnd dZZ:M 6 L L L Uef <br />