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SAN JQ A Q U I N Environmental Health Department <br /> COUNTY <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: 6 510J, M cfL hy CL City: E 5 f�I <br /> Well Location APN: d-c)3 �Ud <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: 11 E jV 0 t Applicant Title: <br /> Applicant Address: 16590 5. iA lt•,t. l2d, City: <br /> Applicant Phone: Applicant email: ✓ a6�✓�� <br /> Property Owner Name: 115AAJ i <br /> Property Owner Address: City: C- G <br /> Property Owner Phone: _ — z1j� S Property Owner email: '6 Cer7% <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft). 0 Acres to be Served by Well: <br /> Use of Well: ❑Domestic X Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gallft): Estimated Pumping Rate(gal/min): �`6ci <br /> Anticipated 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: r <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well:�9 Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑Other: <br /> Total Depth(ft): 15 To: From: <br /> Casing Diameter(in): 6 ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): ap To: From: <br /> Annual Extraction Volume(acre-feet: r.1 - ❑ Estimated ❑ Measured <br /> Specific Capacity(gallminlft): <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 />