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- SAN ) OAQU I N Environmental Health Department <br /> C O U N TY--- <br /> 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: 1,�353 /Z,�_ I City: <br /> Well Location APN: 053r150-/3 <br /> Well Latitude: 3�• 11/1 gS Well Longitude: /z�•OS70g S/q <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: � � Applicant Title: <br /> Applicant Address: a3o�� o- City: qss cco <br /> Applicant Phone: o2U y _ 4FI .. 7g&lel Applicant email: <br /> Property Owner Name: r�G� <br /> Property Owner Address: z City: qj-)- ,Lu <br /> Property Owner Phone: .2Uq. �� A 73G Property Owner email- <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):11 6P_-5;9 Acres to be Served by Well: /U <br /> Use of Well-ToDomestic ® Irrigation El Small Public Water Supply ❑ Municipal Public Water Supply El Industrial El Stock <br /> Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): ,Z:!5* Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): 330 <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): e=330 <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): ®Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): -4 To: From: <br /> Annual Extraction Volume(acre-feet: <;r 19 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 vvww.sjcehd.com <br />