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Address: 24989 N. Tully Road, Acampo <br />LUPUMP PERMIT9620 <br />__ <br />WWW.S1 OV 1866 EAST HAZELTON CA'96205-6232 (209)468-3420 <br />i --�— .O� lehd AVENUE STOCXTON <br />- EXPI ES 1 YEAR FROM DATE ISSUED <br />.) CITYIZIP C rvt <br />PARCEL SIZEJ1�LAND UsE APPLICATION # <br />PHONE A37 <br />ctrnSTATEMp j <br />PHONE <br />w 2-57 <br />CITYISTATEMP C17/ A�6 <br />PHONE <br />CITYISTATUZP^ 7 j <br />NUMBER -,-73 u ' EXPIRATION DATE <br />.CTOR n SLIR _nuTPACTnWrnucru TeuT <br />/-L0- <br />-2-1 - <br />--Z1-- z7- S,rti�I�j <br />/71``�-��% <br />X72- - / pl 5---$✓��vl� <br />(5 Z <br />1 96 2 -7- 7, c-ZA-1 <br />I Bacteria (4391) O Dibromochloropropene (4392) 0 Arsenic (4393) Z F2�0v <br />rah " Industrial 0 Water Quality Monitoring 0 Soil SamplinglCharactertaiion ` t <br />Number <br />Mer System Name Canted Neme or Phone <br />0 Well Alteration/Modification O Other # of borings <br />O Soil Boring(s) #ofborings ❑ Geotechnical <br />❑ Out -Of -Service Well Renewal 0 Cross Connection Repair <br />U Pump Repair ❑ Raise Well Casin <br />'r 0 Cable Tool ❑ Push Point o Other in diameter <br />C"L in diameter ❑ Open Bottom Aravel pack/Gravel Size <br />!r / Conductor Casing Depth' <br />It <br />❑ Steel lastic D Stainleo sSteel ❑ other_al sack <br />rM Sched sack mixl7 g <br />a1 wafer) rySend Cement <br />nt (94 16 ba915-10 D T" <br />❑ Retardant /Accelerator (name) <br />ether <br />adDyi ❑ Other ft Thldc in ❑ Christy Box ❑Stove Pipe <br />th 19 ft Length Water Level �- ft <br />pump Set ft Standing <br />_ HP R� WILL BE DONE IN ACCORDANCE WITH SAN <br />tPPG ACt TION AREdUIHaAilo g NI ALS CERTIFY THAT MY REQUIRED LICENSE IS <br />I RULES AA6 CENSE BOARD AND THAT I AM IN COMPLIANCE WITH ALL <br />7-76- 2,1 -a-, t/& <br />SaS-G.' I <br />TRACTORS STATE LI 953-7697 1 <br />R INSPECTIONS - PLEASE CALL (209) <br />REQUIRED FO DATE <br />TM -9 � ~ <br />w <br />Naseem Ahmed, Registered Environmental Health Specialist <br />ID: WP0042056 <br />