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SAN_,,J Q A Q U 1 N Environmental Health Department <br /> --COU N T Y------ <br /> ls,- Greatr1e5. grows 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: LZdIOA City: ala <br /> Well Location APN: 2d - ():)d <br /> Well Latitude: 17'51`11.99Well Longitude: 20° <br /> Flood Plain Designation: A. Well Elevation: <br /> Applicant Name: Applicant Title: u / <br /> Applicant Address: p S e)ZA9jgfj City: <br /> Applicant Phone: 2 crq-S 2%5 Applicant email: <br /> Property Owner Name:1 00 <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED,JIVELL INFORMATION <br /> Well Total Depth(ft):1 I Lf 04 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): Qr0 Estimated Pumping Rate(gal/min): L(,d <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): >r 1 ) <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): 24l0 To: From: <br /> Casing Diameter(in): Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet: I-P ss 44 ❑ Measured <br /> Specific Capacity(gal/min/ft): /E <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />