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f <br /> f <br /> SAN_wJOAQUIN Environmental Health Department <br /> ---COUNTY- -- <br /> qrovis her,?. <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: D W. T City: �, Ga/ <br /> Well Location APN: /2211 AI <br /> Well Latitude: 1: -0 ,� ( Well Longitude: -12 , vG J c <br /> Flood Plain Designation: Well Elevation: cr <br /> Applicant Name: Applicant Title: N <br /> Applicant Address: N)OaK JcliobCity: M izfi-pll <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: �� >a� City:fmb pi <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED,JNELL INFORMATION <br /> Well Total Depth(ft): ' Acres to be Served by Well: <br /> Use of Well: ❑ Domestic rrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): &0(7) Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): I Estimated Annual Extraction Volume(acre-feet): #`l2 e <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): ��rP <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 WellF00 <br /> Domestic Irrigation ❑ Small Public Water Supply ElMunicipal Public Water Supply ❑ Industrial ❑ Stock <br /> Other: <br /> Total Depth(ft): 7,4-xj To: From: <br /> Casing Diameter(in): tf'ppen Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): To: From: <br /> Annual Extraction Volume(acre-feet:/' ,,-* .,V4 1 Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: Test Result: <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />