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SAN JOAQUIN Environmental c eafth Dees men <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: a 77 S 1 /V E LL/ DTT 2 p City: 0714(-- <br /> Well Location APN: ()C-)'7 _ J 2 O Z <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: 4IF&SC Applicant Title: em be-r' <br /> Applicant Address: 4} : b Yc Oq k RcL City: Loci ) <br /> Applicant Phone; _-479-3763 .Zc 9_ t463-186-1 Applicant email: <br /> Property Owner Name: r r' r <br /> ms LLC_ <br /> Property Owner Address:6L4614 Ltvc QcA k d I Lod City: <br /> Property Owner Phone: Cr_ y 7 q-3-76 3 Property Owner email <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):j I Acres to be Served by Well: Z C) <br /> Use of Well: ' •'Domestic l<Irrigation ❑Small Public Water Supply El Municipal Public Water Supply 13 Industrial ❑ Stock <br /> ❑Other. <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gallmin): <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: <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): 11 K To: From: <br /> Casing Diameter(in): an 1C ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): U.nk_ To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft}: <br /> Other Pumping Tests Performed: f 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 />