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I <br /> 9666 '°N &d S :E 61H '61 'lnr 11U11 P;AI ;D;� <br /> I <br /> I`111J <br /> U�IEf:�IP`s111ffP P�l�NII;� <br /> SAN JZ)A=M CCWZ1YEuvtaatutavrnLH&nt7x DEPARUNM-7 7 sse E4srHAm7I Avtzme-S-r=,[T0N CA9s2v5-CM)458-3420 <br /> NOX-REFUWABLE PERWT CALL 209 953-7697 FORDTSPE=01NI5 EXPIRES I Y>:AR FROM DATE ISSUED <br /> 10234 N Fernwood Rd crrrrzwStorkf-nn <br /> APIu Pnncm.Sszr. •b3 111NA 1JSE APPo]G3TI1]N� a <br /> cv.'raacta%Lm R ort_ ]zr-,&vma-n 489 -5672 <br /> m <br /> orNat,=a,=1632_-�-- E Baker Rte_ c,,,,sT,t Linden CA 95236 <br /> Purviance Drillers , Inc PHuNs209-887-3554 <br /> c0:rtancrotiADDRLSa PO Bog 64 cay/STAl�I�ncTen, CA 95236 <br /> SuocIXS�e.AL'iaR PltOa';= <br /> (StJHCD.YFRFC7DRADDR�SS CtirISIR'tFll�. <br /> Lt—sr (Cst ❑C-bl _--j❑-9P ❑Clhsr N 37 19 23 Expnmmont nnr 7/31 J 19 <br /> ❑o�s;tciPlZt S�..��j Carrera! ne�allCoGfetm Hac',eria{439Y)=DiaromaehtomA�Aane(-0392)�Arsenic{4393) <br /> tNrH�9i-L CfSE II Oarnrs1j q-d ate C lndeatdal G WaterQue51y Ntoxnto:iny O SailSzrnpSnglCha^aCemaiion <br /> Pebfiawatersyzietn <br /> ud,IIrrestrmm G�mrr, waersysc.mnate eam.+u N2tt�.�Frmo=Wmm^�• <br /> Type OF Wawc G New Well C Replacement Well G Web Atcra.tonll,ScrirTmaucn J Other <br /> Mnnr'lodagWells) #ofvrdn CSol aorintgs) aatemfLc GGeofeCl [ai ccrmn�s <br /> -3 Cras-_Cwmucllrnt Repair <br /> ❑Neva Pump Paunp Rep tecemeM C Pump repair RaLseWzll Casing <br /> t•V�L GbiJ5777t/GTranr <br /> DViIImg Method O Mud Ralary GAir Rotary .3 Auger u{fibre Tapl -IPash Ppivd :�_ Other <br /> Propc5ed WWII Deplh tt E=avatiort n ckemeler _Open Bamirn G Grace!Pac:dGrava]Sas in cromeier <br /> G CcodudarCaiclB in drrrt�er / ConductnrLasing Depth l l <br /> Well C e. 17errt22zar in TnidmeSslGatgelASTM Smhad _Siee} :2171.1t= i Staurte Steel �Other I <br /> G7aarseal Depb-e ;; 3 Ne2,zC=nmt(341bb39640GBrcaalad a Send Cemen+ sac:ka&ngalvaWl <br /> G aentonite(24%solids) -:1 oth <br /> Grant Placement Muthen a r-wwad 11 Free Fall _3❑ter C RelardantlA=TAmmtar(aan,) <br /> PEnFStriL hrstalied By O Drt)fer 7 FE=P Ctmlrs10r ❑ Other <br /> e Ccncmte Pedestal COfraenslansNF,dW itLeargtr ftThiclr Fn 9 CtalSryBQ-_ 7 Stave Plpa <br /> Punta 7 Rtlamemitt urtrine ❑Olher HPPrnap Set Tl 5UMLvng Water Lewj fl <br /> i timmy GExa-,y THAT i Awim PREPARED 7Hs APPt1GAnom Am THAT THE WORK tfALLL.BE GONE IN ACCGRmm=-1 n-H SRN <br /> JOAOUiN C013N11Y Ola11NANCES,STAT LAWS, AND RUTS AND REGULATI❑NS. I ALSO L;k- I Y THAT MY REQUIRED IJffiY-E IS <br /> CURRENT ANIS ArTIV-.WITH-rpE CALIFORNIA CGNTF A=RS STATE LICENSE BOARD AND Tmm-r I Ata tN COUPLIANCE WITH ALL <br /> WORKERS CMIPENSAMOId LAWS. <br /> W124 HOl3 ADVANCE MOT(CE REQUIRED FOR JIMPEG'HON5-PLEASE CALL(209)953-76 <br /> stir �L � .: i iGusw �orporare 5ecretar�A� / <br /> I I 1 ( I I ( -7-' -T-1 T - I I I f 1 1 1 1 MLII <br /> EPI I 111 II I ! ! 11P1l1 <br /> I I ! ! I I 1 . I I I I 1 1 <br /> 111 I I I I I II I I I I I I I 11 ' I <br /> IIP ► IIII I II I I ' If ! fI <br /> ! 1 [ li II Iki I I I I I 1 I IIIc ! lit <br /> I I ! ! ! I I YA ow- i I ! I <br /> tlil II I1I'll III i <br /> I 1 <br /> PII ` i11 t � iiPilli ! I9, EIVE® <br /> I tl ► I t Iil1 Ic II ! III <br /> I l I tl IPI ! I I ! I ! <br /> tf ! I ! I I 1 r <br /> E AR7Af2N SE ONLY INCOUNTY <br /> Apgc2f cln Accepted ey ❑�� la <br /> Grmt IOspedion By <br /> nate � SPsc iv. mMT4DARTMENT <br /> Pump hmecfran By tri+1 +nD+ ��h ❑� q l q D MINIM Received <br /> Sol saffag fnspedien By Date Coust uGn_tl Lyell Depth P. <br /> COhtOdENT& <br /> PE SC Received ChDtddJ' Amo=1 PermtU <br /> Cash _ _Remi[[ ❑atE ce xest� lnvoiee tnteUt❑ <br /> Codes tnfa-._ — - - -- - <br /> Y_)1 I -- '. - - i E <br /> I I <br /> Aal <br /> I <br /> H:7 ass- vans <br /> en,rz:1PEGl:nr <br /> £'d tL9£L8860Z oul s.1ell!ia eouel/und d I•I•:£0 61, 66 Int <br />