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SAN 10AQUIN <br />Grear.r,ess grc+vs 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 />,, .. <br />.. .... ...... ....-. ,. <br />WELL i.b«vi4Tlb1l�aND OWNER INFQRJGIAl <br />Well Location Address: 5Z�� <br />E . YgC0DW <br />El Domestic )� Irrigalion <br />❑ Other: <br />Well Location APN: 241r _ 32-0 — 2 <br />Depth of Corcoran Clay (ft): <br />Well Latitude: '70 '2 1(61, <br />Well Longitude: ) j� 12tt �N <br />Flood Plain Designation: <br />Well Elevaliow <br />Anticipated Pumping Schedule (gallday): <br />Applicant Name: (I SA ON Sor is f NC . <br />Applicant Title: CON�� <br />Applicant Address: / CU8 TA 0_7 <br />City: SOANORA <br />Applicant Phone: Z Z- 113t, <br />Applicant email: y dag a La <br />Pumping Rate (gpm): To: <br />From: <br />Property OWnerName- $5f Zt OtdN /ON <br />Property Owner Address: ;jZ*W. 1VjrjgG44 CN <br />C'h': <br />57bCAr,0A/ <br />Property Owner Phone: .Z4 - or ons OZI ti <br />Property Owner small: <br />PR0W$tIJVI=Li (R+FORM" T �I �,.: ; <br />.. ....... ..1-.F,l, . ..,,...:..,., .i�0.'•... :}t.. t. sr r r'. r !. v u::.,..•n +•``t�:.i'_`!; �{`�p,':i'.y�.r':` �'?,;"are'ti;3; r c c <br />s 4 ,..., .a L. :�'-T: ;F!1'9ud'_:`:.=%`gasv,C•.� ��,' .F.::�..R..L q -t <br />Well Total Depth (ft): ,Zx-± Acres to be Served by Well:6ter, <br />Use of Well: <br />El Domestic )� Irrigalion <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply Cl Industrial ❑ Stock <br />Depth of Corcoran Clay (ft): <br />Well #1 Information — <br />Proposed Well Capacity (gallft): <br />Use of Well: <br />Estimated Pumping Rate (gaumin): <br />Anticipated Pumping Schedule (gallday): <br />Estimated Annual Extraction Volume (acre-feet): <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): <br />EXISTiNf3WELLS`IN a7 S,t, <br />:5 - <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 />O Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply <br />❑ Industrial ❑ Stock <br />❑ Other: <br />Total Depth (ft): To: <br />From: <br />Casing Diameter (in): ❑ Open Bottom or Screen Interval (ft): To: <br />From: <br />Pumping Rate (gpm): To: <br />From: <br />Annual Extraction Volume (acre -feat: ❑ Estimated ❑ Measured <br />Specific Capacity (gaUmin/ft): <br />Other Pumping Tests Performed: I Test Result: <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />71 <br />