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IL <br /> -'_� -- SAN 10AQ U I N Environmental Health Department <br /> --COUNTY <br /> Greatness 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 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: fif em o v� City, <br /> Well Location APN: 2 —U <br /> Well Latitude: 3 0 G Well Longitude:�/ <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: 'o o� Applicant Title: <br /> Applicant Address: AA� r47City: —s 's <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: 30C <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 2-c>a Acres to be Served by Well: C(� <br /> Use of Well: ❑ Domestic @Hrrgation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): ! b <br /> Anticipated Pumping Schedule(gal/day): /OOD 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: O <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 ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): A pa To: 2O0 From: / y/ <br /> Casing Diameter(in): / ,'Z ' ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 2 SO To: From: <br /> Annual Extraction Volume(acre-feet: 2 ❑ 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 />