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Q o Q Q U N Environmental Health Department <br /> ---COUNTY— <br /> Greatness groevs here. <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: ; %,nI✓►1ii, jt I City: /' <br /> Well Location APN: p-3 <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: , ,"Z L Applicant Title: awn ev" <br /> y <br /> Applicant Address: ert �r Cit : GIGS C/� 9535 <br /> Applicant Phone: v?pG�_ _ colo Applicant email: C al. <br /> Property Owner Name: e t 1 5 <br /> Property Owner Address: 4--�-pPct C104--r�-(—cam �Hpro/ <br /> Property Owner Phone: _2 ��- perty Owner email n c uhn ' ij o/, /,-7 <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 0250 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(gaVft): p Estimated Pumping Rate(gal/min): o <br /> Anticipated Pumping Schedule(gal/day): 100 Estimated Annual Extraction Volume(acre-feet): a <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): c� <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: A Domestic Id Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> n <br /> Total Depth(ft): 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: ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 j T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />