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C� <br /> f ~�` Health Department <br /> % AN J OAQ U I N Environmental <br /> 'I --COUNTY--- -- <br /> ��`'-s� o%v- 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: y = �r `r .�wt ` ty: <br /> Ci <br /> Well Location APN: <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name; �t Applicant Title: Nl a r c�� <br /> Applicant Address: U ` �� City: <br /> Applicant Phone: U c _ C _ Applicant email: <br /> Property Owner Name: 0, br VL E, r d L L-C <br /> Property Owner Address: il"AL C C City: <br /> Property Owner Phone: c)rt _ `-f - 7 C, Property Owner email C. <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well: <br /> Use of Well: )0 Domesbc ❑ Irrigation L' Small Public Water Supply ❑ Municipal Public Water Supply D Industrial ❑ Stock <br /> ❑Other: <br /> Depth of Corcoran Clay(ft): A)114- <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gallmin): 7S <br /> Anticipated Pumping Schedule(gal/day): tc"I,i,,r„tiJ Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet):l< 2 <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 Ll Stock <br /> ❑Other. <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): u Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): I To: From: <br /> Annual Extraction Volume(acre-feet: ❑ Estimated ❑ Measured{ <br /> Specific Capacity(gal/min/ft)-i <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 />