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S A NUJ U A Q U( N Environmental Health Department <br /> t ;ra C0UNTY--- <br /> `'' Grccrtr�ess 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 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 OWNER INFORMATION. <br /> Well Location Address: , . 011M,1_ > : ,City: , <br /> Well Location APN: <br /> Well Latitude: �: 6 !I­WeIllongitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: Applicant Title: <br /> Applicant Address: City: -k l Ci�) <br /> Applicant Phone: . ,�3( Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WE'LL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well.• <br /> Use of Well: ❑ Domestic Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): 0 ,� Estimated Pumping Rate(gal/min): VD O <br /> Anticipated Pumping Schedule(gal/day): /i 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, l <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: ❑ Domestic kirrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ,�L" )V Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 0-2,z0 To: From: <br /> Annual Extraction Volume(acre-feet: ►7oZ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Nz A 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 />