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SANJOAQUIN <br />COUNTY-- <br />Greotness grows here. <br />Environmental Health Department <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 known. <br />The Environmental Health Department must collect this information before a new well permit is <br />issued and must post the information on the Department's website for public information. <br />WELL LOCATION AND MR INFORMATION <br />Well Location Address: <br />a c City: jy] f 55� <br />Well Location APN: .4,1f. 130 —,0 <br />❑ Domestic 5�-trigation <br />❑ Other: <br />Well Latitude: g7� c�8'�58, �7 <br />Well Longitude: <br />/21 ' 12.`33.56 <br />Flood Plain Designation: <br />Well Elevation:, 37.5— <br />Estimated Pumping Rate (gal/min): i?cc <br />Anticipated Pumping Schedule (gal/day): <br />Applicant Name: 01� <br />Applicant Title: <br />Applicant Address: 0,50 A*dd- Rd- <br />City:InvaleSfn 04�- 95-554-9i <br />Applicant Phone: 909_ C*4 . <br />Applicant email: <br />❑ Estimated ❑ Measured <br />Property Owner Name: +4 <br />Property Owner Address: &00j SlSho bPi. 6 ft, /VV <br />City: <br />-:*,v 4amoq Ck. g45e <br />Property Owner Phone: 92,5-. Qqq. 3450 <br />Property Owner email: <br />eAJ.,i�l'-�fU•xa//<40.W <br />PROPOSED WELL INFORMATION <br />Well Total Depth (ft): a0 <br />0 ` Acres to be Served by Well: 9. $' <br />Use of Well: <br />❑ Domestic 5�-trigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />V- Ar <br />Proposed Well Capacity (gal/ft):.2 <br />❑ Open Bottom or Screen Interval (ft): <br />Estimated Pumping Rate (gal/min): i?cc <br />Anticipated Pumping Schedule (gal/day): <br />Estimated Annual Extraction Volume (acre-feet): <br />Pumping Rate (gpm): <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />2.. <br />:0101 <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: <br />❑ Domestic ❑ Irrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Total Depth (ft): <br />❑ Open Bottom or Screen Interval (ft): <br />To: From: <br />Casing Diameter (in): <br />To: From: <br />Pumping Rate (gpm): <br />To: From: <br />Annual Extraction Volume (acre-feet: <br />❑ Estimated ❑ Measured <br />Specific Capacity (gal/min/ft): <br />Other Pumping Tests Performed: <br />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 />