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SA �J 0 AQ U I N Environmental Health Department <br /> --COUNTY--- <br /> �`- �'• redness grows 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: <br /> Well Location APN: 2_ — o'sc1— Ilse <br /> Well Latitude: ,` �s�` Well Longitude: 2- �'21' <br /> Flood Plain Designation: Well Elevation: s <br /> Applicant Name: Canepa and Sons,Inc. Applicant Title: Contractor <br /> Applicant Address: 14384 Cuesta Court City: Sonora <br /> Applicant Phone: (209)532-1136 Applicant email: csonsdrilling@gmail.com <br /> Property Owner Name: �- YF n- 9 'on <br /> Property Owner Address: Z.,., City:wozi:o-'4 Cj`-r11-1, <br /> Property Owner Phone: el t- ) - Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth (ft): Acres to be Served by Well: <br /> Use of Well: <br /> ❑ Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply x1ndustrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): -7! a It <br /> Anticipated Pumping Schedule(gal/day): .eco) 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: s <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: ❑ Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <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:1 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 />