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APPLICATION FOR WELLJPUMP PERMIT <br /> �AN JOAOUIN COUNTY PUBLIC HEALTH SERVI� <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,STOCKTON,CA 95202 <br /> (209)468-3420 <br /> NON-REFUNDABLE PERMIT EXPIRES I YEAR FROM OAIE ISSUED t/p5 7 J �CQ` 4r tG <br /> ICIMPMM IN TFORM161 <br /> IF LKAMN la INK RV MAnt 701111 RAN JOAOVd COVNRY TOR A MRAIR TO C.MIFAJCT AIn1gO IMIALL THE MW DFBCRIREO.7101 AMMAIbN It MADE IN C'OMRIANCf.11 MN <br /> MAOINN COUNTY DEVFIORAFM TRLI,CRAFTER N 1115.3 AND TIIE RTANOANDS OF qM MA011d COVNT PIn11C NFALPII ttg RPE..[NWO...t Nfµlll dNMON. <br /> MRMDxfewnETTTT,376 Lincoln Center 90 Stockton 1AncURIT0 1097-41-46 <br /> (AMON.xAM[c/o ons T. ra s awg ev nff e-Fr cke- econAoorcaPEmeryv e. 94(0 - 2 nMM S10-652-4500 <br /> 11350 COMMcrOR AODR[Ba LICE M.Of I <br /> on er ar ace <br /> Rue coMnncronTransglobal Emvironmental Geochemistry ARutxee Rancho Cordova. CA 95741fc•706568 nroM 816-853-8010 <br /> rv.of wELLnvmn O MW W m ❑.RtAT'NAw A tt ❑wlmomM Ant• ❑onRR <br /> 0m°tAturroN ❑WELL.11M MPAM ❑curt.F.xMET MPA. ❑VARDA f%TMClmx KRt• ,I <br /> ❑Ne..❑Two, NP. RFTII wnP eR_R. .Mt WAIL.DF D <br /> 0 Y OF MMPI <br /> 0Out or WOORM Wtu ❑DEDMra1CUMSu• aotp.Ruo Vapor R <br /> ❑R I'Mon.N: <br /> EF-MR--A TOM of WED. o o •I O <br /> A <br /> 11...,.At ❑ORN ROTOM DIA.of wflL E%CAVAfroN 1-inch dA.Oi COHWCTOq CANNO_n/8 O <br /> 13 MuI#MF`I.IF ODMVEt PAC.RFRE 1 YIEOFCANMRRPNI n/a dA.OFTAEUOA. n/a O <br /> 11 rtutw d AI. 00.V1N TFPl1101 OMM REAL n/a BnCWWAmNcemen t-ben tun ite B <br /> 11MAMAIRMAG OptMR FROM BEµ.11,41mC By n/a ..IT RMNO NAMC n/a E <br /> 'f NONNO.NO OMVI BEµMkjMIDT VBe [IN. COMnRI TMBrµRV nPAMR OYee 0Ne S <br /> APPROX.VM"multiple borings 5-65 Ft bgs Lot.""NvlR Bo%IRow MM 1 <br /> RIOMgFo COMPORRITIONDIRUNO M"Noru Mw NOTARY AMWtARY AMEF CARLe otmel Hydralic Push <br /> I HENRY CFntNY MAT I HAVE MEPA.O 11111 APPLICATION AM MAT 1M wW IML RE MM.ACCOMANCE A TII aM MMI <br /> AN COIIIIfY OMdANCFB..All I.-AM MxfB AM <br /> d.RAIMNaOFtllE AN MAIXANCOVMY.MAN!DAIWA OR LWFNR[O AOfM'e e.NAIUP{CERTIFIES 111E roftto IO:'IMAR"THAI.TIM nd MAANPI M INE WDNL FON.Itu <br /> NIM AT."Iq nBMO,1.1µt MT fMROV RRBONB IMACI TO WON%MAM'R COMVMSAt10N"M M CµTOn11.t.'COMMCTOR'B IIINNO ON AVRCOMMCI.O N°NATUM CONTRIFB <br /> TIN MLLOWI ! 'I CERT In..tlN RRFOMIAMF OF".W AR FON.,ICN[Ills"A"n,IB 16°MD,1 BIIALL EMROV"MOM OURAcl r°RFMRNANY C°MPFMaATION"WO OF <br /> cA11fOwA.- 11.APLRANIM ID.IIBN°1:1.1.ADVANCE F°R ALL M...INF•RMNs Avuttu4RR.MM <br /> IB.COMR[r[RWIM WR <br /> AT LOn AMA PROFITED.,'/13_ / ,/I.-/I e- Tlue Site Project Manager R„e��z/9 <br /> ROT MM Iden le M.1e1 Rexe_'Ie <br /> t. <br /> }f.. A.D.OF1T 1fRORMoBMA.BT10ORRd. l.I'm Proff"Ry. A. LOMMpN OF IRWAMd I <br /> yn.OR YbMpFD <br /> FOR. OF M OWN.dMFM.M AM MR. N. !%POF WWA° dBMµSY.119. <br /> MO OMLRu`.AMx OFµt EA.. AM PROMAFD R.LC.1w.OFWLLIMOF ou . rRT R <br /> . <br /> aTructU1xB,.CIUOIM COVERED ARIAS <br /> NCN At PAt.B,dMVfWAYe,AND WNNB. 1L r1 <br /> 14 <br /> V <br /> .sIY.. <br /> . <br /> W EF <br /> eu 7 rb FR. <br /> 'n <br /> f_ <br /> m <br /> , F <br /> b ' <br /> _ r <br /> �7 N4 h F ♦ .en Y <br /> 95 .r Y <br /> oA � <br /> ss <br /> 14 <br /> 13 <br /> o,.M aawx.R er � Dx. n.PPmW.en.R er Y D.,e <br /> R+In.11..B.Pe11en b R.,. <br /> c.—M <br /> AccovxnxR RNlr: AMI 1AF1 <br /> M Man REIMo mom,.E Mo cMC%IrcAMI M..., OAt POMITnEnWcl nlOVFeI xUMe91 dwmE <br /> g -3 a <br /> Pub.Health BRrv. EWro.173(IAM) <br />