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}'J Zi SAN J O A Q U I N Environmental Health Department <br /> w, i. ---COUNTY--- - <br /> Greotress qrows her <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: e W- , 1AeANS RD City: <br /> Well Location APN: l f jll f d joa <br /> Well Latitude: /t/,0 Well Longitude: /bd <br /> Flood Plain Designation: WA Well Elevation:1/11A <br /> Applicant Name: k.IAAI /Zp fj Applicant Title: dWreC A//,man/ W&t&- <br /> Applicant Address: %.S9 OAkMOn/ GKCGe City: G1w,-yAono- <br /> Applicant Phone: f.0 b 10b6 Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: 7-7 �y� g(,�� L-) City: fe <br /> Property Owner Phone: a09 33� Property Owner email: 1A <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): do Acres to be Served by Well: O <br /> Use of Well: ❑ Domestic KIrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): 304f) 9 Pkt,,, Estimated Pumping Rate(gal/min): opt 60 <br /> Anticipated Pumping Schedule(gal/day): 3ej 060 Estimated Annual Extraction Volume(acre-feet): /JO <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): 300 <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: Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): e� To: Ve From: -W O <br /> Casing Diameter(in): 6 4' ❑ Open Bottom or Screen Interval(ft): To: (?O From: o <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): j a <br /> Other Pumping Tests Performed: VA Test Result: A11.6 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />