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SAN J OAQ U I N Environmental Health Department <br /> ---COU NTY--- - <br /> � Grentnrss grows ! err <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: 4,y4 1City: L <br /> Well Location APN: 0 pp / <br /> Well Latitude:3 Y 0 Well Longitude: /,?-0 . 'f 7 U <br /> Flood Plain Designation: Well Elevation: / q oef <br /> Applicant Name: Gk f Applicant Title: Ot <br /> Applicant Address: 9,7 wvv k , z City: Lcc(,' <br /> Applicant Phone: 9,,99:.3 )(/ - l/7;4,5" Applicant email: <br /> Property Owner Name: OU Oo k f t L L <br /> Property Owner Address: 9 fo ©fir City: 6u(I S <br /> Property Owner Phone: g j _ I Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): (�l _11"11- Acres to be Served by Well: <br /> !' Use of Well: <br /> ❑ Domestic Q'r igation ❑ Small Public Water Supply ❑ Municipal Public Water Supply El Industrial El Stock <br /> ' ❑ Other: <br /> Depth of Corcoran Clay(ft): fit 4k <br /> Proposed Well Capacity(gal/ft): "Lt>0 Estimated Pumping Rate(gal/min): l ov <br /> Anticipated Pumping Schedule(gal/day): 1 o�j'Z 1,v I Estimated Annual Extraction Volume(acre-feet): ,;L <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <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 0111rrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): - To: From: <br /> Annual Extraction Volume(acre-feet: -,4-0 � Cf Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: 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 />