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SAN J OAQU I N Environmental Health Department <br /> -- -COUNTY <br /> Greatness <br /> COUNTYGreatness grows heri,. <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 /> , /// / 6 <br /> WELL LOCATION AN OWNER INFORMATION <br /> Well Location Address: � cll 6alme kD City: ave t <br /> Well Location APN: — 0 q d — 0,5 <br /> Well Latitude: Np Well Longitude: /A <br /> Flood Plain Designation: n/,4 Well Elevation:INA <br /> Applicant Name: 14142AeAel bqkll 4MP Applicant Title: <br /> Applicant Address: 5668 0)4,K"/Vl. U�2CW lit' City: <br /> Applicant Phone: gd-S 7p 1666 Applicant email:A1h*4a,,lf wouk f LJet1�? rrKc .60& <br /> Property Owner Name: A u.7w Rro I& <br /> Property Owner Address: 1,'505 S TLUD City: T <br /> Property Owner Phone: Svv; W.-y,,, VI kra^ a�aJ Property Owner email m0farms �;Wl .60M <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): e 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): -oho Estimated Pumping Rate(gal/min): OjJ <br /> Anticipated Pumping Schedule(gal/day): (] 00 0 Estimated Annual Extraction Volume(acre-feet): 300 <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): -600 <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: 1 <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 /�Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): a00 To: gQ From: JO 6 <br /> Casing Diameter(in): a' ❑ Open Bottom or Screen Interval(ft): To: 05aa-15 From: �f <br /> Pumping Rate(gpm): S60 To: From: <br /> Annual Extraction Volume(acre-feet: 36 X Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): / 000 <br /> Other Pumping Tests Performed: ^49MF Test Result: /UA <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />