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SAN JOAQUIN Environmental Health Department New Well Information Pursuant to California Water Code, Section 13808, all new wells that do not meet the exemption criteria must submit the following required information, to the extent that can be reasonably known. The Environmental Health Department must collect this information before a new well permit is issued and must post the information on the Department's website for public information. WELL LOCATION AND OWNER INFORMATION Total Number of Existing Wells on Property: - Please complete the information below for every well on property. Use extra paper if needed Well Location Address: 6 '51 City I E 5 C- /�f Well Location APN: t-,ZU 3 =;Z ❑ Domestic X, Irrigation ❑ Other: Well Latitude: ❑ Stock Well Longitude: Flood Plain Designation: Well Elevatiomi Estimated Pumping Rate (gal/min): _W1 C11 Anticipated Pumping Schedule (gal/day): Applicant Name14 E U ,- �n urs �N Applicant Title: Applicant Address: 657 o 5, Lc A, p k y &Y City: E 5 C_,.q-2 0 Applicant Phone: _ 9 i�5 ._ c� J 5 Applicant email: ✓E�N:rs�✓Dt 4 /. Property Owner Name:l f g�o�-Ajl �� L Property Owner Address:1652 U m / City: , -�G G Property Owner Phone:) - _ e i7 — rac5S5 Property Owner email: y,,-,¢,,;ttt;--}&.e PROPOSED WELL INFORMATION Total Number of Existing Wells on Property: - Please complete the information below for every well on property. Use extra paper if needed Well #1 Information Well Total Depth (ft): 1 J150 Acres to be Served by Well: Total Depth (ft): `Stj Use of Well: ❑ Domestic X, Irrigation ❑ Other: ❑ Small Public Water Supply G Municipal Public Water Supply ❑ Industrial ❑ Stock Depth of Corcoran Clay (ft): Specific Capacity (gallminlft):l Proposed Well Capacity (gal/ft): Estimated Pumping Rate (gal/min): _W1 C11 Anticipated Pumping Schedule (gal/day): Estimated Annual Extraction Volume (acre-feet): Estimated Cumulative Extraction Volume before January 1, 2020 (acre-feet): MINE C cin EXISTING WELLS INFORMATION Total Number of Existing Wells on Property: - Please complete the information below for every well on property. Use extra paper if needed Well #1 Information Use of Well: Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock C Other: Total Depth (ft): `Stj To: From ❑ Open Bottom or Screen Interval (ft): To: From: To: From: Casing Diameter (in): Pumping Rate (gpm): ac) Annual Extraction Volume (acre-feet:;J /YT -r7 - r Estimated 11Measured Specific Capacity (gallminlft):l Other Pumping Tests Performed:) Test Result: 1868 E Hazelton Avenue I Stockton. California 95205 I T 209 468-3420 1 F 209 464-0138 1 wvrrv.sjcehd.com