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y <br /> S A N J O A Q U I N Environmental Health Department <br /> -- COUNTY <br /> G ot')eS5 rcowS !�0r <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: ^� , City: 2:1P4.4" <br /> Well Location APN: -�, �..p v <br /> Well Latitude: 1S• 16512,1 Well Longitude: JZO, Qs344 <br /> Flood Plain Designation: fflmWell Elevation:12-q I <br /> If <br /> Applicant Name: OSA 4jL) Applicant Title: d W A41— <br /> Applicant Address: v{ City: pulv `o <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: 1 City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I Soo,, Acres to be Served by Well:1 t.b <br /> Use of Well: ❑ Domestic Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): AZO Estimated Pumping Rate(gal/min): 00 <br /> Anticipated Pumping Schedule(gal/day): 28p, rr,v Estimated Annual Extraction Volume(acre-feet): I•eq,S <br /> Estidated Cumulative Extraction Volume before January 1,2020(acre-feet): c L <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: 2— <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 El Small Public Water Supply El Municipal Public Water Supply El Industrial El Stock <br /> ❑ Other: <br /> Total Depth(ft): L/2U To: fbU 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: 2 A{C✓c 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 />