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SAN J 0 A Q U I N Environmental Health Department <br /> "... - C O U N T Y--------- <br /> Grea�, ��: ;rows 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: -71 City: f K y <br /> Well Location APN: 0- 0—070 <br /> Well Latitude: Is. l� 1 Zt Well Longitude: j20, QS3`14 <br /> Flood Plain Designation: ffl 1AWell Elevation: Z <br /> Applicant Name: v Applicant Title: d wn-te <br /> Applicant Address: City: p4/v D <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: u✓� City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSEDRELL INFORMATION <br /> Well Total Depth(ft): 00 Acres to be Served by Well: b <br /> Use of Well: <br /> ❑ Domestic Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): Al A <br /> Proposed Well Capacity(gal/ft): p Estimated Pumping Rate(gal/min): p(,7 <br /> Anticipated Pumping Schedule(gal/day): v Estimated Annual Extraction Volume(acre-feet): /Y4 S <br /> Estidated Cumulative Extraction Volume before January 1, 2020(acre-feet): r L 1 L L1 <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 Wel: <br /> (Irrigation El Small Public Water Supply ❑ Municipal Public Water Supply El Industrial ❑ Stock <br /> Other: <br /> Total Depth(ft): x•/20 To: ((0 U 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: 21i{C mac. 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 />