|
APPLICATION FOR INELUPUMP PERMIT
<br /> ' n SAN JOADUIN COUNTY PUBLIC HEALTH SERVICES,
<br /> ENVIRONMENTAL HEALTH DIVISION
<br /> P.O.BOX 388F 304 EAST WEBER AVENUE,STOCMN,CA 95201588
<br /> (206)461-3420 .
<br /> 10If-REFUROAKE POINT ESPIAES 1 TEAR BION 1ATI"SUED ,
<br /> ICAMIIMM In Trylbbi
<br /> AFPUCATWN 10 HERE by MAR TO THE BAN"AWN COUNTY FOO A FTAWT TO CONETRJ C ANOON NnALL TFH W C(.RI TM,ARVCAIgN M MAO,IN COMnIN10E FRI"SAN
<br /> .MAOIIM COVMY RV]LOFMFNT TME,tNATEA 9-1116.3 FRO THE RANOANDE OF SAN JORMIM COUNTY FUN6 NFMTM eITVCF,,fNNIbMAFMAL N ,F,WW".
<br /> JOB AconwroR Al.M 15800 GRANTL.INE RDD. Cm TRACY PARCEL,aR
<br /> ,JAM
<br /> OFaarB MME MANUEL AMAREL ADDRs, 15800 GRANTLINE 'RD. TRACYRgw, 836-4021
<br /> apN oR HENNINGS BROS. DRILLING CO. "AOMEn3525 PELANDALE AVE. 400 2908131,,0•,, 545-1185
<br /> ,RCOMRAmit App1EB, MIT mew.
<br /> TYR OF WELINUM1IP: :i R,W w L 63 MsumMNT W,LL ❑MaxnDRIw MSL IT 13 OTHN
<br /> Q N,TAMAyT- CSAR& ElAflvAM QCroxcdxrecY RMAM ❑VA10n E1RRALTIONWMLI
<br /> ❑NwO NSM M.I. vMN REMF BET—__Fr. IIMT WATER IEVn a
<br /> NTFECFFM]n
<br /> 13 EuraanNvg,wat ❑e,o,Nvmcfuweu• ��❑1w.,�w M.
<br /> G
<br /> ®Rfl1JJCTgN1 BENTONITE �i GG1 �!h' '7 M (O5 �]"1' uic.Ff"Z1
<br /> om un vRG wDJ eox,TnucnoxfRCNgA IONf A
<br /> El•AURIYAL ❑ORN BOTTOM "A,Oi WF LL EBCAVATNIN 1211 MA.OF CORWCMR CARING a
<br /> W OOMBRIC VATS 06MWL PACRH2E Ty"OF CAEINQ(Ilr TLS PVC M.OF WELL CANIS1 D
<br /> ❑RMIJCIMUMCB'A] ❑DRIVEN OE✓Tx OF OlO11T RAL 1 O_ r,RCINCATgN BENTNITE R
<br /> CI MNDATpxua 11 omFn ewur SEAL NInAEJm, HENNTNG5 Mau,BwmNAME
<br /> ❑MOAMFNO � - DNaur sm m.m:®Y— O
<br /> / w
<br /> cpuurE Rn„rAt BYdKLEMQY..
<br /> ...OMR IUJO• LOCRNIO CMBSTIOI NOZI,rOVEM
<br /> RNIroFN CORIFIRMTgxNEWNO MET1pO: MUO HoTMY X AIR NOTARY AVOER LNLE OTHER O
<br /> I xFERY CERTIFY,NAT I HAVE RNPA EO TNIS—CATKIN AMO THAT TNI V.O W.WTIL n CONE M ACCOIOANCr WNN B4I JOAWN COUNTYOMNANCES.•TATE UW.AxO MREI D
<br /> NEONATIONR OF TM BAN JOAOU N COUNTY.NOM OryNOT DRLN:FMRp ADEM','ONAi1RE COHI THE rO1JOWM0:'I CMIFY THAT M THE R1.ORMD(OF TME YFO K FORyF4MR
<br /> TMHIMWFD.1•NALL NOT[MROYIERION,FUFXCTTO WOMAF4Y',CgAIpFATOMUW OFCAL6OM'IA'LpNrNACT011'/XIM40fl FVRLONTMCTMO bNAI(IIG LEq
<br /> TMMI&O FOUAVANO: '1
<br /> WFa1,1A: TMf ANFJCAN TTMNAVT,T INEATNLLF 34HOURSMACAE OV!ATMMEE,YAORR AU Rl WMUN:NM wo Nm.FM.1 I1WI I GALL FMO.gRIIFEOONR},NW,.IFACTT TONWOAREA
<br /> COAMOIfATON UW
<br /> MOMOFD.
<br /> ,Ii�IFi�1-Iv man 1 �•w., n11 �YL „ ���—��% 1rAG pN JUNE 26. 199
<br /> .rluN m�.+m mN::MN. 1 �f
<br /> 1. xAMEI Os rtRFTs on MAOF x[ARGT TO On eOVNMNp TME FNOIFRTY. ,.LOtwT1Ox DFNW,F fIYIAG,MfIOIII II•I[MOR RKIIOnO
<br /> O VM1ME OFTNERp RRTV,dY1M]ONA NMN.ANO NORF.dIIEO.N. Fi1AN ION.1 nWAR WMRAL/YRFM•.
<br /> ].OIMENNONEO OMUNFS ANO LOCATION OF ALL E11RINa D FIgW nD ,. LOCATgN OF MILL,WITMN MWS OF OM HUWRIO FNTY R.
<br /> STINCTUM.,INCLUDING COVURED ARG,MIC"M PATIOS,p AV,,AEC WAIFS, ON THE ROnNY OR ADJONNO FgRJTTY.
<br /> m. .
<br /> ^ � � F, .
<br /> p S FIN
<br /> 11 � A
<br /> r ;
<br /> P
<br /> yr
<br /> 1d1 �r 1UN 2 b fy9F:
<br /> I A x
<br /> L� ; j ' I coal 1 All'11 SERF C
<br /> lmcp em RE MILT
<br /> D7z3z9L n.m e.Isuen,r o.l.
<br /> D-V-I.n x.w ta. N / II OM. 7
<br /> Z 3 0 — 5,3 .5 Hf2_
<br /> nccounnnD Exn: �fyy AIw FAu
<br /> I.
<br /> C.. IEF 1,'�0 .g.TMFIITI. Om.". I"CBVFO IY WE FMMITWNIVIEE RFOIRFT RIMSN MWIC.
<br /> I D3O437
<br /> 3 '' 030
<br />
|