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APPLICATION FOO WELLIP'_IMP FEWIT ::;: .i(lAn 'a; c0ilijT7 ,-'!113LX riEAL711 SERTC.7.1 p f.NYiSOP!PNUMV. 'iFALT11 DIVISION BOX:3313, .30=4 EASTWEBER EBER INVENUE, STOCKT01,1, CA 95201.,3PO (209) 409-3420 310(!BIFUNDARLE PERMIT EXPIRES 1 YEAR FROM DATE ISSUED_ lCom ental APPLICAI ION IS IIERE BY MADE TO,THE SAN JOAOUIN Coi1NIY rOn A PEnWr TO CON8Ti ,RiterAND On INSTALL 711E WORK DF RC RIDFD.THIS APT•LICATION 18 MADE IN COMPIIANCF.WIrlI SAN JOAOUIN COUNTY DEVELOPMEPrr TITLE.C/IAFTFR 9.1 1 1$.3 Arlo rim.STANDARDS OF RAN JOAOUIN COUNTY PUBLIC 11EAI.T11;EMACEP.FtIVRIONMF.PrTAL IIEALTIt DIVISION. JOB AUORESS/OR APt1I 1766 Monte Diablo Avenue Stockton _ " ---._...-- ---------•r.ITv_— -- _rnncEl.a1zE/nrNl _ PIAM-' Russ'all 1203 N. Carlt Ji: f= "T--46'4-4i x•39 COFIFfV,CTDH Lush Geosciances -3 Buszner�—ss�/D�r . , 9i6-737-9294 -'-------- __ADDRFrr-- a.:C.t-o—,_._J.5-8.2..Q._.—I lca�C44 71 PHONES _ AUR CONTRACTOR yL& TX- t 1ers._j-_PO_Box 51 ADDiwnt; Rio Vista, 94571 IJcr 710678707-374-2815 fYt'E OF WELL/PVF,:n• 19 NRN WEI L ❑ 1tT^': FlA,'GF WFLL —__- I MO)m OF:)NO ME U.A _ -...I OiFlfri_ ❑ INSTALLATION ❑ Y✓r11.SYs7 F.ki ncf,A In ❑ C-top-,COHr1F:T nErA!n YJ VAm.n E)(TnACTION WELL✓_�F=� �/ ❑New❑Renwlr H.P. nFFTtf PUPAP RET FT. _2 0-f t-_ n ITYPt:OF i`(1b1P) _ "-�- _._ � rIRr,T WAfFR Lr:VEI �J r-� ❑ nur.Dr-^FRVICF VAiLL ❑ 0F0VIIYRICAL WELL I I ROIL!IOnIND n LJ OEBTRIICTION: INTENDED USE TYPE OF WEIl � COPFSTnl1CTJON SPECIFICAFION8 """�"�'�' 11 INDUSTRIAL ❑OPEN BOTTOM DIA.OF WELL EXCAVA rION— 1 0—1 2 i n _ D!A.Or CONDUCTOR UL1 CARING_ (� nt!a r C1 DOMESTIC/Fn1VAI'F. GRAVEL PACK!r .r Pea TYPE OF CARIftO/BTEFI S'V.: PVC r?IA.OF Wi.IL CASINO -..- _ l ❑ I JBLICRAUNICI?AL ❑MWEN - ---- DEFTIt OF(;ROUT.rFAl_ 1 5 r t Cr•ECIFICnTIPN bentonite R IRRIGATION/AO ❑orHFn r.ROU7 r.FAI !"IrTA!I.FD,;Y D ---- 1I tr`mie RDl/T IIRAtfD L� 7AON7T OIIINO Gnour REAL PUFAM)!JL��JYws [IN. ---- COi1CIlE'I E PEOFR TAI.BY UPII 1_EA�Yw ❑No AP'TIOX.DEPTH BOX1R7o VF f"r^ ., PROPo"')CONSTTIUCTTONMA1LLUNG METHOD: AI{q)tlO T,aCY Ain no rARY _-- _----- -- - --- AUCER--�---- 01HER -- IIE•iERY CERTIFYTHAT t IIAVE:'fIF.PARFO TIIIR Ar"I IrA Intl A110 TIIAT 7HE NOI1<V'AL1.BE MINE M ACCORDANCE mrll RANJOA(1(I1P1 COUa FY O::OIPIANCEB.IRATE IAWR,AND nIFLER ANO REGULATIONS OF THE RAN JOAQUIN COl/P(Y. Ho":O%VNER OR LICENSED ADENVO BIGPIATURF,CERTIFIES THE FOLLOWING:-1 CE)IT I-THAI IN TIIE PERFORMANCE OF Tf/E WORK FOR VARCII THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY PEnSONI)RUBJECT TO WOnKMAN'S COMPENSATION LAWS OF CALWOWA.' CONTnACTOFVS IIIIMNo On SUBCONTRACTING SIONATURE CERTIFIER THE FOLLOWING: 'I CERTIFY THAT IN THE PFnFORf.:A%CF Cr Ti IE WORK FOR W11IC11 TI 119 MnMIT IS ISRUF.O.I SHALL EMPI.OY r£)100 NR SUBJECT TO'NOnKMAN'•COMPM11AT10N I.'?WR nr CAII-)RNIA.• TH4 A•'"VV:T MUST CA;1.. Ir-)t. ;rv• .. i . ..rte rrn A!.!RFA:,:RBD!7!,-7';:C,-1-)`-. 7 ^.QI^'_ ^Z. 'C• ...,. Y: 7:'7, •`/." --- ----.----- .BIS President 2-21-96 LU':.,(:.•: -Dr.+•N te•r.6wlw1^wcr,iw ..___._._.._- .. . .;Cti Jr:T'F:•.;7, Orf i;J;:Jti::E:12{�Si Yi)U7;...:Uni11NG PIF.('701'Efil'i. ._..-.- _- ___-..____. .• 'iNr'!>tF.OF TF%E",OF`.",G!VIN0 Dlt'EtIR!Dr:S di�%N, A. 10(.'A11rN1 Or HOIFRF REWAGF DISPORAI.SYRTrm On Pr'fwonLD yO;t;.'!.'R'CT;GtI. ::'AIC:IGrI•!'!eAlla GF DIF-'O?AL RY.7TE:t^.S. .r, f 111AF.NSIONED OUTLINES AND LOCATION OF Ai 0;'1:i1P)G A>e)PI omsfD LUC1'r1')rl OP 1W1 I,r,Aql-t/try I1A6tUR OT UfIF I/VHOIIFD'9i'r GT I(UCTUREB,1`ICLU,1t1O CDVEREO AF'.E:?5 SUCI!?S 1'.\(!O!),UT!IVcWAYT,AND WAIKfi. ON P'r7DKITTY. See Attached II i, - Appllowpon Aaceplrel ay (i,mA Irnpwcllon By _ ----- Dc•Ifl•r rlrn inyneel'•: ttr - _-___.__________..___ _._.-.-.-_ FAO ONLY: CCOUNTW -�- — -._.._.__._.. ----.__.------• R� Alf),I — —_—• --__.._. __.-__ ._.__SII _______ PE FE CODES 'c INFO-'�APAOUNr RF7Af TTFD IFr ,r/CA0F1_� RECOVER BY D - - •� ^--- 1- ------•-- - - ---- _-�- -ATE 7•Th71 f/bEl_ocs nrnvrFs i N(.;NSF?( - tH`IOICF. { —•----i------ °� __ 111 'L- � I —`� � -E-r- ►-