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SAN.J 0A U I N Environmental Health Department <br /> ° Uo,';Ck2 1 —COUNTY— <br /> Greatness <br /> COUNTYGreatness grows here. <br /> New Well Information <br /> Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption criteria must submit <br /> the following required information, to the extent that can be reasonably known. The Environmental Health Department <br /> must collect this information before a new well permit is issued and must post the information on the Department's <br /> website for public information. <br /> EXEMPTION CRITERIA, <br /> Well meets the following Exemption: <br /> Well not located in a critically overdrafted basin. <br /> Well owner will be a de minimis extractor: maximum two acre-feet or less per year being extracted for domestic <br /> purposes only. <br /> Replacement well with same extraction as the existing well that it is replacing. The existing well must be <br /> destro ed under permit. <br /> Public agency that substantially meets or exceeds these requirements through another requirement of the,law. <br /> In order to be exempt, the applicant shall document the laws that substantially meet or exceed these <br /> requirements and how the requirements of those laws were met. <br /> A city or county municipal well to provide water supply solely for residents of the city or county. <br /> WELL LOCATION AND.OWNER INFORMATION + <br /> Well Location Address: Zq I 1 111 A-V A Ve City: FS&I I Or% <br /> Well Location APN: - <br /> Well Latitude: ,-7 Well Lon itude: — 20.9 �,'J <br /> Flood Plain Designation: Well Elevation: o <br /> Applicant Name: v es Applicant Title: U tut/ t <br /> Applicant Address: -Lt LCi7;L <1. Y v r Ci h <br /> Applicant Phone: 5 X72 Applicant email: <br /> Pro ert Owner Name: 2n b 4? a -e <br /> Property Owner Address: 7-116o, -S Cit : <br /> Property Owner Phone: 'rj Pro e Owner email: <br /> PROPOSED WELL.INFORMATION <br /> Well Total De th ft: Acres to be Served by Well: S91-4C i <br /> Use of Well: <br /> ❑ Domestic Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> —Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity al/ft: ►� Estimated Pumping Rate al/min <br /> Antici ated Pumping Schedule al/da : 2 0 0e, v Estimated Annual Extraction Volume(acre-feet): t <br /> j3 etc ar, 5 tnoArs p,&Af,Zistimated Cumulative Extraction Volume before January 1,2020 acre-feet: <br /> O'K ti 61*1 -e- <br /> EXISTING WELLS.INFORMATIO.N <br /> Number Existing Wells on Property: Please complete the information below for every well on property. Use extra paper if needed. <br /> Well#1 Information <br /> Use of Well: Domestic ❑ Irrigation ❑ Small Public Wa er S pply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: 3 00 5 '4:MIAvs� � ��31� � 7 <br /> Total Depth(ft)-: To: �30 From: cca <br /> Casing Diameter(in): 1, a Wpen Botto or Screen Interval To: From: <br /> Pumping Rate m : 20 To: From: <br /> Annual Extraction Volume(acre-feet: Estimated ❑ Measured <br /> Specific Capacity al/min/ft <br /> Other Pumping Tests.Performed: I Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />