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.tan 10 01 05:55p p.2 <br />�tc I ,/) & K <br />.1p.WELLIPUMP PERMIT <br />SAN JOAQUtN COURrf ENyM NmETITAL HEALTm D®ARTmENr t 6fi8 E,Lsr HA�rGN AVLN i• - <br />NON-PjFUNDAsu PERMIT S�ncxroN CA sssns - (2n9) acaaaw <br />CALL 09 953-7697 FOR INSPECnoNs EXPIRES ! YEAR FROM DATE ISSUED <br />JosA=Rass 28915 F. Furrk Rd rarminaton <br />CROSS STR=Er Hwy 4 - c7yzp 11 <br />APr� R 7- 3 5 1 PARCELsr7F ?int <br />fats USE At+>ucAnoNJF <br />DwNIERNAME Valley --crest Tree Co <br />PNdNE <br />OWNER AMAESS P. O. Box 5019 �, A tiroodl and Ni11s, C� <br />�CKMACTOR Purviance Drillers, .Inc. pH0 209-887-3 5 <br />:OXTRACTM ADMR:MP. O. $�64 1nC1en, <br />Crr-efSTATEMp <br />SU9=NTRA=0R <br />P44ONE <br />CTTY/STAman, <br />uca;9E �{ C-57 U C-61 Dug C ottrer Nu►a ER 377923 7 l 31 11 5 <br />E7?ULlTIpN DATE <br />GEaGRAA41CAL IwaRYATM, Coordinatfas X y <br />I --E 000j..-- dzr�e,tla • <br />IlriTownshipo_arnpGRna�nCgeturractBrvxS <br />O gEMOWAgncuRural pindushial GWaL-rqu'eCt <br />ion <br />xWv <br />rn <br />„c — <br />TYPE Oa Wc�c �Nev�tM1lPlr OReNaoemencweu OWeliAlte ratiOnRV1 <br />oa��n ❑ Ottl <br />G f for nrin9 WeJr(s) ef_wells G Soil U ing(s) FctOonnps <br />fl Out<xService Well C Out-0f$ervicr Weu R ­f r ej <br />Alathod • Mud Rurn --LZ �.�" <br />ry u A'rr F2otary ❑ Auper fl cable Tool D Push Pow C Other <br />d Weir t-Pth�ft E=--Li-n: ZZ � � in diameter / Open Bottom G G <br />O Conductor Casing in diameter / Conduc�er Casing Deplhfj ��� S ¢e in diamfilar <br />using Dlameter_[,k_ in TbidcnaWG2ugeJASTM SdWd57� <br />­­'2nn _ . 2 N Steel n Plastic a SSainless5ren� n nn.e. <br />1 HEREBY CERTIFY THAT I HAVE PREP <br />JOAQIlITi COUNTY DRDINANCES, STATE LAWM <br />CURRENT AND ACTIVE WITN 7NE CALIFORNIA <br />WORKERS COMPENRnTmm f aw <br />iiz�inc wutcn rrlti ESE DONE IN ACCORDANCE WITH SAN <br />GM. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />UCEN[SE BOARD AND THAT I AM IN CC)NpLIANCE WITH ALL <br />NOTICE REQUIRED FOR INSPECTIONS -PLEASE CALL (209)2s3-7697 <br />a <br />=� Tme Corporate Secret�/ 9 �1 5 <br />'MITI t _ <br />pgYM <br />ECFV ��T <br />"PA.RTMENT USf ONLY <br />P4vicatian Accepted By y ` Date (7 <br />gree EmployeelD� <br />Gmut tin By Date ❑ SPECLpL Well Permit <br />Sail Boring Pump 19 �` Date '❑ WAIvr3t Received <br />CONAfENTS Inspection By Date CansWCt,ed Welf Depm R <br />PeI Sr_ Ioe...,�..... ...__.a. _ _ <br />Date <br />swa>ae i� ? <br />ljml< <br />v -mL /PUmP PERWr <br />Received Time Jun,13, 2015 10:25AM No -8982 <br />