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' , 3: Op <br /> ' WELL/PUMP PERMIT <br /> SAX JOQrZM COIMrY ENVIRQYMENIAL HEAL]H DUARIMM JOIE WEBER Ave 3"PL•SccKion'CA 95202' (309)"M2O <br /> t NON-REPUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JMADDRESS 700 L111PE RD. cmr&p TRACY <br /> n <br /> a <br /> KASSON RD, e <br /> CROSSSiR[Er APN ZCS'2�O- PARC¢L&]L/. yLANB U3[APPWCAiIOnp � <br /> ' OWXERNAME LACORIO LAUD INVESTUENTS PxwB 481-5201 <br /> OwnexAwREvs 2771 E. FRENCH CAMP RD. crrv/sTAT p MANTECA, CA 95336 <br /> COarMOrOR HENNINGS BROS. DRILLING CO.. INC. exora 5A5-1165 <br /> ' CDNTRAC RADwLES 3525 PELANDALE AVE. cmisrawzu, MODESTO, CA 95356 <br /> SDBfO1.TKALIOR PHwE T <br /> SI16oONitUCTOR Avovr% Crrv19TAti2m ` <br /> t LA. d:C47 ❑Cbl ❑D-09 Clower NUMBER29Dft13 EKPERAnDNDATE MAY 31, 2006 <br /> GEOORAPHIGLINEORNATION: Onerellmha .X' Y Towcsblp_ R&W_ &eRon <br /> INTENDED USE madcT.,. ❑ImpfiedAgrieulmral ❑Inelobtl ❑Water QualityMonitoring O Soil Sampling/Cbamecrintion <br /> ❑Public Water <br /> Daia.,ft.b'. . a"51.1aune am.a, ,ebm <br /> ' TYPE OF WOKE; N'1k,u,Well ❑Replacement Well O Well AlermiriMaiifiaGoo ❑Ower -- <br /> ❑M.oimringWeU(s)_d.fwells ❑Soil BoBng(s) °pfp0""® ❑GeomchNal. <br /> ❑Om-0fService Well ❑Out-0f8ervice Well Renewal ❑Cmss{..nation Repair <br /> ❑New Pum ❑Fannin R I...t ❑Put. ft.i, <br /> ' WELLCONSTRDLTION <br /> DIIIII,Methatl 1I71L1ud Binary ❑Air Briery ❑Auger ❑Cable Ta.l ❑Push Point ❑Owe <br /> Prepo"Will Depw 200 fl EAwvati.n 14" _i,dieracer ❑Open Bmam ,'( travel Park/Gravel Siac i.diameter <br /> ❑Cerduetm Ca RES in diamemr / Cenducwr Casing Dcpw fl <br /> Well CMing Diamner B in ickneNGaugdASTM ScbW 16 D C L ❑arcel kb Plastic O SminleM atcel ❑Own <br /> Groot Sal o'di Ea ❑Neat CEmat(Wu,A.g/5-f0gpl»vrer) ❑Sand Cement maJ m¢/]pl water <br /> 1'YYimmnite QO°A mlida) .Manufacturer Spa%solids °. Name ❑Spes.n File ❑Spas SubmiveJ <br /> Grout PHeemoat Methal ) tic-Pall ❑Fra Fall ❑Ower ❑Retardant/Aatlwtor(neme) <br /> EERTaTA6 haoxiled By .Driller 0Pump Conti ❑ Do., <br /> ' O Coxart Pmam Dlmenabna:Wltlth R length R Thick in ❑Chrim gee ❑Stove PIDe <br /> PUMr ❑Submersible ❑Tuwine ❑phn HP P mp gat R gmMin Wats Levd R <br /> 1 HERESY CERTIFY THAT 1 HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br /> IOAQUI.N COUNTY ORDINANCES,STATE LAWS,AND RULES AND REGULATION& 1 ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br /> CURRENT AND ACTIVE_WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT i AM IN COMPLIANCE WITH ALL <br /> ---VpORRERS COMPENSATION LAM. <br /> MI 'IMUM 24HOUR ADVANCE N IC REQUIRED FOR INSPECTIONS <br /> SlcxeD �` I E SUPERVISOR DATE MAR. 3, 2006 <br /> .. . .... .. . . .. ... <br /> r p <br /> NIR NI E A <br /> M <br /> ' A x <br /> i <br /> DEPA TMENT USE ONLY <br /> Appliadon Aceepted8 Dau Ara Well <br /> (iq <br /> ' NW Inspanonx� ❑ SPECIAL Well Permit <br /> Pump lnapation By / Dae ❑ WAIVER Received <br /> CpvMmcad Wall Depth R <br /> Co TS �' 75 -„L - <br /> 1( <br /> / / <br /> ' PE SC Raelvetl Io3/ Amoxm Pam1U <br /> DaM Invoiced W41IDN <br /> Cada <br /> III". B a I RemWd,12b ServkeR ,uatd <br /> 114 -,41 lfvoOd 147 1 <br /> 1 <br />