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X.- -KTON PUMP COMPANY <br /> FR(M STOZ- FAX NO. : 209 Jan. 19 2001 12:28PM P2 <br /> PUBLIC HEALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL 11EA1:'1-11.D?ij%10N <br /> Kar$A Furst,M.D., M.P.H., Health Oficer <br /> 304 Fast Weber Avenue, Vurd Floor • Stockton, CA 95202 <br /> 209/468.342o <br /> APPLICATION <br /> 1*1 <br /> f1EPT11 OF WELL SEA0, <br /> WAIVER. <br /> l Wt;U.PRAMITNUMIwit. SP-W,257577 <br /> crWE 'FAL DE-PT;{rcquired by <br /> Sim Joaqwj)C0Q] tan&r.j--- L 1h bw LLS <br /> (SiTL.,A!x)Ruv%) M4 <br /> This Waiver is x-1 uftcrldve to the foLowing circumstalicv <br /> A <br /> Ibis Waiyet i5 <br /> approve bastd oI)xc Wllowiw <br /> d il <br /> 41 -� —apltl�� <br /> AFPK0vLT>i3y: l -31 <br /> 0 <br /> DATL <br /> The folt,owing conditions are pls6d on Ue-well COUStruction permit and may not he m6dificci: <br /> k* Thu ProPcnYoAffter shall sigh*jjs applicatioll'lnil*ticknOwlcdg*,dist ific wC11 constniction deviales ,,rV, <br /> miniattun d(*tl) Of wen SCAT surds. <br /> 2. The arinular gelt'l shall teminate in an impervivii3(dyer. <br /> To v*ify the watcr quality 60n,jhf <br /> well,water saMples 9611 be Iftilyzed f6r 6c 11ollowilig c1lu,71jzlis of <br /> I- <br /> UAW & IlAjljt7t� A&-j S -1,va <br /> tb r7 0 <br /> tille'uadersigne-d owuer 01 the property identifts.&-aboVe, hereby request a Waiver from tilt, <br /> Minimum 'well sL-:il depth st2nd1rds of San Joaquin County based on the iftform"on m)tcd <br /> above. 't ackno"JcOge that I&s WAiver infOrinWiOn 4hould be disclosed to subsksent <br /> -PI&6 y crs <br /> 'NA, <br /> RL Ol' <br /> Clr <br /> .13 N <br /> 111ti'Y'rL , - ;;- —;;;z —=. z-- <br /> y,iuADDRI;SS; <br /> VTY,STATE,Z,-; <br /> C, <br /> A Divxvion of%.in jx;a9jjjjj Coulity lie.-11(11 C-!r ServIces <br />