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1 <br /> SAN�IOAQUIN p <br /> J Environmental Health Department <br /> COUNTY <br /> Greotness grows 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 <br /> known. The Environmental Health Department must collect this information before a new well <br /> permit is issued and must post the information on the Department's website for public information. <br /> WELL LOCATION AND OWNER INFORMATION <br /> Well Location Address: 2 4 3 3,8 a City: w cA <br /> Well Location APN: _ ld <br /> Well Latitude: 3T N Well Longitude: tti, 1,0^ Vel <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: r1At e Applicant Title: pvi Ke <br /> Applicant Address: bA2.S AwAAe_ X City: AltaAgrog <br /> Applicant Phone: 92Z-4213 Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSEDAELL INFORMATION <br /> Well Total Depth (ft): Acres to be Served by Well: So <br /> Use of Well: ❑ DomesticIrrigation 1:1 Small Public Water Supply El Municipal Public Water Supply 11 Industrial ❑ Stock <br /> ❑ Other: _ ` <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): / 40 <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1, 2020(acre-feet): `.-.Z•�/wrt ac*t <br /> EXISTING WELLSINFORMATION , r <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 omestic El Irrigation ❑ Small Public Water Supply 13 Municipal Public Water Supply 1:1 Industrial El Stock <br /> ❑ Other: <br /> Total Depth(ft): /00 To: From: <br /> Casing Diameter(in): 614/ ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 1d To: From: <br /> Annual Extraction Volume(acre-feet: Ie=�h 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 />