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N\ SAN J O A Q U I N Environmental Health Department <br /> COUNTY - <br /> `=� Gr-otness grogvhere. <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: a City: <br /> Well Location APN: <br /> Well Latitude: Well Longitude: - (Z/ <br /> Flood Plain Designation: Well Elevation: -71, y' <br /> Applicant Name: �`yr l/� /h Applicant Title: <br /> Applicant Address: uf� �, 2 City: <br /> Applicant Phone: 772 - Z 75- Applicant email: <br /> Property Owner Name: � t�//�/1L1u�cle_ <br /> Property Owner Address: 20 Z S` pa S4,�, /1� 4C,r?h9 City: <br /> Property Owner Phone: ap� 7V7 _ yy 37 Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 1 2 6,nAcres to be Served by Well: <br /> Use of Well: <br /> ❑ Domestic Vrrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): -;2 y, V 7 Estimated Pumping Rate(gal/min): y <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1, 2020(acre-feet): /2 <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 Wel?EO <br /> Domestic El Irrigation Ll Small Public Water Supply 11 Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): 8 ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): '53 To: From: <br /> Annual Extraction Volume(acre-feet: Alp ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): 4111/4 <br /> Other Pumping Tests Peri[ormed:1 Test Result: 71 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />