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APPLICATION FOR WELUPUMP PERMIT <br /> N JOAQUIN COUNTY PUBLIC HEALTH SERVICLW <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468.3420 <br /> RON REFUNDABLE PERMIT F%FIRER 1 1'EAR FROM BATE ISSUED <br /> IC.MPIIM In TIIy11cIl4 <br /> AfFUCAIpN IE INK lY MADE TO THE RAN JOAGIM COUNFV FOR A 77"IO CONBIIWGI ANOpq INCIALL 111E WOXI(OEICgnO.TIXX AIRICAIpN la MME W COMRIIHC'E Wllll GAN <br /> MAWXN COUNTY OMLOPMFM TITLE,THARER 9.11 1 1.3 AND TIN RTANOAMG OF RAN JOAOIAN COUNry gmllC 11Eµ111 RINAMEEP.ENWRONMENIµHEALTH WHA... <br /> Jae AooKGwR ARM EE,,incoln ((',',¢¢n[er ury Stockton PARCEL MLFEAg1� ,�J AJ p„Q-. Q„7 <br /> Se T}f"ZTs8Ef21f[;-pEipi(Q311t f OCD£ 1 l >-TF76- (A R <br /> oWmun-mmE c/o Donald T. Bradsh w L i -F i k -R poola:RR Bmeryvil le, CA 4608-1827 RRHEI <br /> cEMK.croR AEpIFGG LEG, RpKf <br /> WE O.WRMTOR Gregg In-Situ, Inc. 950 Nawe R . (510)717°SHOO-- <br /> AooKUMartInez. CA 9455'1 IICI CA-656407 RroK1 <br /> jyR.FwfLLmNAP' ❑NEW WELL ❑KI VEAINT WELL ❑MowroRM W[u E ❑EnAG <br /> ❑INerAlurpN ❑WELL rvns.KFMR ❑Cno6ec...lul At ❑WRG.E nAAVTWw Mn.I J <br /> 0._0 A.PW N.P. INITH RINP It. R. FIT WATER LLn VR OF MMR O <br /> ❑V.,MW .11 <br /> ❑OF....F,.".WFILImo_ BON ROIONO R <br /> ❑OfeigllCflOH: <br /> INIfNOFO UR! YPf Oi O rR IOM IT CIF 10 E A <br /> ❑INOVNAHN ❑ORNROROM M&MW'ELL"CAVATXIN 9-1,D hFc VIA.OFCOMUCTORCASM N/p O <br /> ❑OOMEnICNAIVAn ❑MLAWL PAcxgal ITR OF CAE1MmEv,vvc N/A WA.OF MIL CANON N/A O <br /> ❑RIu1CMUNO:N'µ ❑DEW. OE.HOFOMUTuµ Total Depth RRCXN.AIpNCement-Bentonite R <br /> ❑MPoGA1roMM ❑OTHER oMvMALWGIAMw,,y Contractor GROW RRANO NAME N/A E <br /> ❑MOMNNEEM �ro�I nMTANRo:�vr ON. COHCKTEROEnALRVWWLE.O. OD. e <br /> AIrMy.oEnll 80 feet LOCATION CKnen wxmoaE lR N/A <br /> R <br /> R1oMfEV EONfIRVEIIGNIOIRUXO MnNDO: AIDED MTAM MR MIMY AWfR CARIE OlNfq NYdraUliC FUBEI <br /> I Nf;EV CfRTRY"'AT <br /> I HAVE MFPMFO TMI AF1EAAlpNM RM <br /> AT TME WOM Wlll RF OOHE M A«OMANCE WITH GAN JOAOWN COUNTY OMIHAWE ,nAIE"M.AM MILES ANO <br /> KOVIATIONR OF 1K RAN AM AGVCO DIFF.IbMf.1.OR I....ED AGENT'9 NONATUK CIRTAN.THE MMOMM:'I CERF"THAT W THE PERFORMANCE OF 111E WOR(MA ENHICH <br /> NO...IIR IRRUFO,I...MT EMPLOY RRMNR INNCI TO W.A.A.'I COMRNEAOON LAWS OF CALIFORNIA.-CONTRACTOR'G IIINNO OR We CONTRACTING EMRE CETRIER <br /> mlE FOLLOWING 'ICM" <br /> TIM"IN THE KKORMANCE OF THE WORK FOR WHICH ATTR KAMIT IR MEMO,1 WIM1 EMPLOY RNONG IURECI TO WORWANY COMFEMIAVON LAWS OF <br /> CNIFOMIA' 1MA NIMNIC nIMLIM Of ADVANCE 100 ALL <br /> MORAND INCKOIRMI AT IROGI 4114i231.COMRLIF RMWIIG AT LOWER AMA RWWOEV. <br /> eN�,.ex /L �� Ys✓ l rLTp IL/.�M. <br /> Site Proiect ManageroN. /5 <br /> ROT MM 1W.w f.IN"MM._ to <br /> I.NAME.OF STATUS OR MME NIAMEY IO On ROVNWNO 111E gpRgry, I LOCATION OF HOUR nVIMI WMMM EYnEM On MRAND <br /> ..,.WOIMl <br /> f. OUTLWf OF 111E MANDAT wW N II.N..0 W.I.OIKCTM W EXPANRIW <br /> ON Of liADI MMV GµWaTiMe, <br /> O.OIMENMONEO OULMP`AND,LOCATION OF ALL P`XMNW AND RWPoUO E.LOCATION Of WELLR WTfMN MdVR OF CMI WAR.fNT,R. <br /> kETXVC`Ims,,M.Cf1Ltuum COVERED.AKAS WCHAN PATIOI,DMIEWAA'V`S,.WMAS, OH TIf groP[IIfY011/pJ01NWO RgMIRy, <br /> 41 k <br /> Ei <br /> II `1 <br /> > U <br /> I a <br /> �91 _ riA_ 6 p <br /> l.� MF P ,A° A <br /> gq�t <br /> ys...- B, <br /> Nil <br /> y L <br /> ,nc w..� q <br /> Ae .°eC�.�_k : <br /> onMlTMegl ml EMv o <br /> NIE.MHn Mayltl RY /Y 1 //'L(LGE�CfC� p.M_ I'l� Nr <br /> M.M IA.rrlbn RT_.. on. W Mr..Er_..Y 0.1. <br /> uru�.Iw.M.rra.A ar o.I. <br /> E.n•mA..: CL U o f SIS cKto.-7 Svfcvoct�,y1E-ren,-I t e✓m lt- <br /> ?Ze e m p 10 I f1 j, <br /> AccOUN11XO ONlY: NOI PACE <br /> If <br /> COD" <br /> i[EEND µ10VNI XQNYTFO CIIECXIMAIII KCRVEOIY OAIF IVAIIINNAT CE MOUE.iT11 0—1 M1MEM INVOICE <br /> S o-A w vl3t� a <br /> Pub.Health SEW.-Envlro.173(1197) <br />