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SANCtd0A0UIN <br />COUNTY <br />Greatness 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 <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: <br />CEJ 3 cr i ', <br />City: o n <br />Well Location APN: <br />�—; _, <br />Depth of Corcoran Clay (ft): <br />Well Latitude: <br />" 7.. 8 l2z <br />Well Longitude: <br />— 12,1. 099 79d <br />Flood Plain Designation: <br />5-6;) k <br />Well Elevation: <br />Estimated ❑ Measured <br />Specific Capacity (gal/min/ft):. <br />Applicant Name: <br />RA l Ili <br />Applicant Title: 0 u, <br />Applicant Address: <br />3cj l <br />City: <br />Applicant Phone: <br />_ C <br />Applicant email: <br />Property Owner Name: <br />Property Owner Address: <br />City: <br />Property Owner Phone: <br />Property Owner email: <br />PROPOSEDAELL INFORMATION <br />Well Total Depth (ft): 11 3so, <br />Acres to be Served by Well: 16), <br />Use of Well; <br />Use of Weill: <br />❑ Domestic jglrrigation <br />❑ Other: <br />❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial El Stock <br />Depth of Corcoran Clay (ft): <br />f} <br />Proposed Well Capacity (gal/ft): <br />p V -- Estimated Pumping Rate (gal/min): /$D 6 <br />Anticipated Pumping Schedule (gal/day): <br />.12 <br />�u - r wZtimated Annual Extraction Volume (acre-feet): 50 U <br />From: <br />From: <br />Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): 6 c ca> <br />"It 4 <br />,V(4 -4 - <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 />ElSmall Public Water Supply 11 Municipal Public Water Supply ❑ Industrial ❑ Stock <br />Total Depth (ft): 2,Sv <br />Casing Diameter (in): & " <br />Pumping Rate (gpm): <br />XOpen Bottom or Screen Interval (ft): <br />To: <br />From: <br />To: <br />To: <br />From: <br />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 />