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S A Wid 0 A0 U I N Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> New Well Information <br /> Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption <br /> criteria must submit the following required information, to the extent that can be reasonably <br /> known. The Environmental Health Department must collect this information before a new well <br /> permit is issued and must post the information on the Department's website for public information. <br /> WELL LOCATION AND OWNER,INFORMATION <br /> Well Location Address: A Nr h I Q City: <br /> Well Location APN: _ Q;CG - q q <br /> Well Latitude: -�a ' � # Well LongitudT. /2-/ °6o " j L^ 95-%/ <br /> Flood Plain Designation: Yr LA. Well Elevation: it <br /> Applicant Name: Ru R ; �I�Q �t r2`g j Applicant Title: <br /> Applicant Address: 1 h c 4.k 2 City: �« <br /> Applicant Phone: _ 0_( Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: c> c H ( City: r- of ri <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL-INFORMATION <br /> Well Total Depth(ft): Ljee? ' Acres to be Served by Well: <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ElMunicipal Public Water Supply ElIndustrial 13Stock <br /> X Other: Fl" Fr44,r e+'e- <br /> Depth of Corcoran Clay(ft): MIA <br /> Proposed Well Capacity(gal/ft): /24„3 Estimated Pumping Rate(gal/min): 12_cc> 478.0 <br /> Anticipated Pumping Schedule(gal/day): .$ Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: U9160mestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): Z C7 To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: 1 qe) From: ?r� <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: Estimated E easured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: AIVA <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />