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SAN JOAQUIN Environmental Health Department <br /> —.__.. COUNTY _ _. <br /> Gre-irness grows herd. <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: City: <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: pplicant Title: <br /> Applicant Address: City: <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMA <br /> Well Total Depth Acres to be Served by Well: <br /> Use of Well: ❑ Domes' ❑ Irrigation ElSmall Public Water Supply El Municipal Public Water Supply ❑ Industrial El Stock <br /> El0 r: <br /> epth of Corcoran Clay(ft): <br /> roposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): <br /> A .cipated Pumping Schedule(gal/day): 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: ' <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: 11 Domestic t�igation El Small Public Water Supply El Municipal Public Water Supply El Industrial El Stock <br /> ❑ Other: <br /> Total Depth(ft): �?90 To: From: <br /> Casing Diameter(in): 'r, ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): am0 Ein Kne --n To: From: <br /> Annual Extraction Volume(acre-feet: 106, IT"Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): Lh Kn <br /> Other Pumping Tests Performed: n 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 />