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WELL/PUMP PERMIT , . It` <br /> SAN JOAqum Cotwry ENvIstM'MLNTALKLALTn DLrARIMENT 304 E Warn An 3-FL-9rot=roN CA 95202-(X9)1663120 <br /> NON-REFUNDARI.E PE um" CALL(209)953-7697 FOR INsrEcnoNs EXPIRES I YEAR rRaw DATE LsnmD <br /> JON ADD■ccv 31411 Kass= R n r1 25:2-3W:y l crtYm. Tracy <br /> CROS7m— C✓In Am21.LL !A■CjEL SIT) I LAND IIR AAS,1GTlOf/r � <br /> OwpamA=RnS 4690 Discovery Point Discovery Bay. CA 94 4 <br /> COVIRAMIt Bertram DrillInc.ng. InPnoNt 406-259--2532 <br /> COVMAl7URADDRES%. 510 Klenck Lane ctnfsrATV/Jr <br /> subcoNTRACTt1Y I llow I <br /> SLWO..WRACTOR ADDRM Cr[YISYATTlLT <br /> u ursL Jj c57 0 C-61 G D49 ❑tithe NumzLR 703688 !x►+■Annrt Davit 3-31-05 L <br /> GLocR.APHII'AIAKMRMATI0N: Cosrelnatra X Y Towssr4_ Range Set4o■— <br /> lN'rENDLD UsL vrrivue ❑Impbon/Agiatltund 0 1cduwal G Wucr Quell Muni-8 G Soil S..pUa/Q,wwmrtrar_RD V <br /> O Public Willer System_-_ _ _ <br /> u mom,Own Oatsr �+��� <br /> TrrE(WWoRL 0NewWei 0 Replacement Well ❑Well AltcaoomModtfication 0Telt Hole eat Exc an er (� <br /> ..rtooa. rdb«os. <br /> [3Monitoring Weil(j)_#of wells LlSoilc Boriag(s). G Oreotechn" <br /> O Well Dvvection a oulofscvice Weil o Ow-Orservile Wei Resc. v <br /> C New Pump ❑ _ Replacement ❑ R L <br /> WELL <br /> it O Crofeorrre400 <br /> Drilling McIM 1�F.lud Rnury XNAv RDtnry G Auysr O Cable Tool ❑Pu&Pout 0 Orbe _ <br /> Proposed wen repth 2 6 5 ft Fscii-6on 5- �in diametc O Open Bottom O Gmvd Part 1 Gravel Site u diameter <br /> ❑Conductor Caning r�•' m dimwlc i Conductor Gawk Depth 265 ft <br /> We■Caving Daman__ in ThiclmndGaugdAbTTM Sched 0 Soal 0 Plastic 0 Stwolcm Steel G OIW <br /> Groot Sed Depth 76 5 ft 0 Nest Cement(A/fb bag/SIO qd wmer) 0 Sand Cement _.w1ek MVx;7 gal waif J V Q <br /> bentonite(209:solids) G Mwufacntne Spa%solids % Name 0 Specs os File O Space Suboutted ti ) ,V <br /> Groat Ptrcemeet Method X 1�>+_ ❑Fttx Fdl ❑Olhcs _ t7 It�.urasot Aceinnwr(tame) �• �, <br /> PEDr_vrAI. IRnalted 6v 0 Driller 0 Plow Convitaar <br /> 0 Coocroc Pedestal Dln_eadona: Widen n Lengtb—--a n ck---- in a Clrtan Floeo Swrr C <br /> Pustr O Submersible G Turbine 0 Other _ HP pamp Sa R Sundmg Wale 1&,,dft t� <br /> WELL DuTRUCTIIRt 0 Open Bonen O Gravel Peek ❑Utrasod O Older <br /> Well Diameter in Tout Depth 11 Depth to Wnc 4 O Gating In be Pmfonand fmm fl b ft <br /> SesOog Material O Neat Cement(91 fb brSC/160 gu!nater) A Sand Cemtm lark au:/7 gal water ❑Bemorttie PeNeu ^ <br /> �l <br /> Q Berttmtite(2(::wilds) c1Mmufaedaes Spa Y solids % Nam:-- 0 Spec on Ftic O Specs Stdmntted <br /> rla o,rat Methsd G pungred G Ftee Fall G Oahe <br /> L-_ G Cwtpl to with Mushroom Ca ft below Stade G to Esimig(SurWe Pad <br /> 1 HEREBY CERTIFY THAT 1 HAVE PREPARED T111S APPLICATION AND TRAT IRE WORK WIL..HE DONE IN ACCORDA.YCE WTM SAN <br /> JOAQUI.N CO(r.%-n oRDI\AWES,STArK LAWS,AND RULES AND REGULATIO'N$, 1 ALSO CERTIFY THAT MY REQUDILD LICENSE IS \\T Cy <br /> CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STAT).LDCUM BOARD AND THAT 1 AM IN COMPIJANCE WITH ALL <br /> WORKERS CO E,NSATION LAWS. C <br /> N1IN11.11 Ni 24 If ADVANCE NOTICE REQLTTRED FOR INSPECHON5 <br /> ' A DArt -a7 br-o <br /> L 14– <br /> t <br /> .� <br /> 5 <br /> VARTMlM U3li O Y A� <br /> _� Os1c ------ <br /> 7, 7 � mN <br /> Date O SPECIAL Well Permit <br /> TMte 13 WAIVER Received <br /> \\\ Destruction In:pesioD <br /> By__ Date , Constructed Well Depth It yy <br /> COMM jr> 01 11971 ore <br /> /4e/ <br /> �A O Coen is Reeetvee f D� r 1111..+ee r was IDPBY <br /> J <br /> 0 <br /> Ia:3B4- <br /> Ad �� ;n rxmrl5AV-5 31��� <br /> 1 �arr-d U,gv`P �-�0 0 <br /> 'z� N <br /> 744 <br /> 1 L�.s �� 1.,m ENVIRONMEN 1 HEALTH <br /> y`�� aZ `1`4, PERMIT/SERVICES <br /> `f f /t't'�t �,I,..:,r,� U�t� (;/ �'.(l,1�r""� �Z p^'1..G'K81 Y,ry�, �__-•__._._._..__ ,..., .� �_. .. _-... .,--, <br />