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SAN JOAQUIN Environmental Health Department <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: v�i7City: c­ . <br /> Well Location APN: 4 G_ / <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: S L ,. Well Elevation: <br /> Applicant Name: ;s -- Applicant Title: <br /> Applicant Address: Sc City: <br /> Applicant Phone: p Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I Acres to be Served by Well: G 7 <br /> Use of Well: Ty <br /> Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> Other:l)ct jr- <br /> Depth of Corcoran Clay(ft): A ,, <br /> Proposed Well Capacity(gal/ft): Q Estimated Pumping Rate(gal/min): ( SQ <br /> Anticipated Pumping Schedule(gal/day): S-C. epd Estimated Annual Extraction Volume(acre-feet):Ig O <br /> p 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: <br /> Domestic ❑ Irrigation EISmall Public Water Supply ElMunicipal Public Water Supply ElIndustrial ❑ Stock <br /> _ <br /> Other:dot i r— ` <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): r' ❑ Open Bottom or Screen Interval(ft): To: V_ From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet:0.?_ ❑ Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: 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 />