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05/12/2014 04:30 2099873574 PAGE 02 <br />WELLIPUMP PERMIT <br />SAN JoAatmr CaxTY ExvlR wmffAL MEALTtt OEPARTvdw 1988 EAST mmuow Aymm - ST9 KTm CA 962cs - (2o9) Ade -342o <br />MEFUNDABLE VERNIFT I:ALL Ny) tow-lb"t FvK 1rr9VLUTTUF-. LAVIML�l I YEAR FROM UATE rs$UEU <br />oRtss 21014 F, Comstock Rd ,,,,Linden, CA q 52-36 <br />S,,,, DeMaitini Lane APN 091 -340-02 PARCP�st�1 9 • lu(NDt15E APPUWTroNi: <br />NAM2 William&Katherine Anderson RET trust PNatE209-470-1 395 <br />14290 E. Comstock Rd. CnY/STA,FfZ,p Linden CA 95236 <br />tnoa Purviance Drillers, Inc. p 09-88 - <br />%CTM Anorts:se P. O. BcK 64 CrtYMTATEMP Linden, <br />WRACTOR — - PMOME - - _ - - - <br />Anne <br />457 0 "l 110-09 ❑ <br />CnY18TAT WMP <br />Wrms a 3 7 7 9 2 3 E]rPotAT necnATe 7/31/15 <br />IBOGRAMIMALINFORMATION: CocrdinviesX Y Township Rana Factlon <br />INTgneaVa ❑ Doanestl bB ❑ IrroatiordAgriwlurnl 0 Indu&tiel ❑ Water Quality Monitoring 0 W Samplro'Charactartna lan <br />0 Public Wahar 3yetem <br />KdRr*0M>t'on1 OrrMt• <br />Ty"21 m ❑ NW VVe1 D ReplammerR Well ❑ Well A tareUorllModlilcation ❑ Other <br />itV ntmring We1(a) i of wells n Goll Boring(a) N°tbodres U Geotecttncnl <br />dubOfSeMce Wall 0 Oul-0}Seniloe Wall Reneunl p Crov Conmellon RepO <br />DrNHng YatnOd U Wd Rotary 0 Alr Rotary 0 AVW r, CaW9 Tool 0 Push Polrn 0 Other <br />Proposed lA%ll Depth—ft E=vvation In Gla neter 0 Open Bottom 0 Ge" PacivGfl vel Sia& In diameter <br />ri Conductor Casing In Moo mWA r Conduttr Casing Depen - R <br />Wan Cochfg phrnylrgr _ In ThkknQMT,errgerASTM Solied a Steel o Plaelic ❑ 6te1"lesa Steel n Other <br />Grout Seal avift ft 0 N40 CWvnt (AI Ib b$b.ro got wftf) 0 Sand sack mbr/7 gel water <br />0 Bentanh(20%solda) o Gilkey <br />Grout Plownwd Method 0 PtxnpW U Free Nn 0 OI!,er 0 Retardant I Amereratar (deme) <br />MZW& IraMlled By o Dtfilor o Pump Con"Oor r� Other <br />Concrete PadflDlmarretotro: YVidln rt LertgN R ThrJr in ❑ Cltffatb Bcor 0 SWW" Pipe <br />Pump ❑ Subtrr tile❑ TwNne ❑ Other HIP PurnP Set R GtrldhVV"WLeirel R <br />I wREBY CERTIFY THAT I HAVE PRSDAM T1419 APPLICATION AND THAT THE MRK WR -I- BE DONE W ACCOROANCIZ WRH SAN <br />JOAQUIN COUNTY ORD(NANCEB, STATE LAWS, AND RULES AND REWUI.ATIONS. I ALSO CERTIFY THAT MY REQW,*0 UCENSE 15 <br />CLHOlENT AND ACTIVE WITH THE CALIFOfWA CONIWCTORS STATE LICENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />WORKERS OOMPEmunoN LAWS. <br />M M 24 ANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASEALL (2'") 853-76" <br />Sm �„ti.r,.�e� Tri Corporate Secret 5'Xa5/12/14_ <br />,E <br />DEPARTMENT USE ONLY }� <br />Appll=Om AcoipW By �� �� +IgL' Dene Aro.-I)-04-119 04 1 Employee too C 7 �Lo <br />Orotd Inspodtloe ay Do" 0 SPECIAL Well Partnit <br />Pump InRpoeft Br Date D WAIVER ReoalVed <br />SO4 Bodnp Inspsgbn BY Dau! Corratruetid Wall Dept" R <br />COMMENTo <br />zz <br />® Z LIJ <br />LU L)zz <br />Awa <br />�1 <br />U r -r Q ° o <br />LJ = 1 0�_ <br />zW <br />z ¢ <br />w <br />a = <br />Received Time May,12, 2014 4:35PM No,6035 <br />BTU <br />