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t <br /> - � R <br /> SAN J OAQ u I N Environmental Health Department <br /> L <; _- . COUNTY __._ <br /> ,P Greatness draws herd <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 INFORM TIQN <br /> Well Location Address• City: <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation:1 Well Elevation: <br /> 4 <br /> Applicant Name Applicant Title: <br /> Applicant Address: City: <br /> Applicant Phon C^ Applicant email: <br /> Property Owner Name) i <br /> Property Owner Add rej City: - <br /> Property Owner Ph uq2 Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): C? Acres to be Served by Well: .4/ <br /> Use of Well: ❑ Domestic Irrigation D Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): n, o-7�- Estimated Pumping Rate(gal/min): O_0 <br /> Anticipated Pumping Schedule(gal/day): 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: / <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): 1 f ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm):l To: From: <br /> Annual Extraction Volume(acre-feet: Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): <br /> Other Pumping Tests Performed: I Test Result: <br /> 1868 E. Hazelton Avenue ( Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />