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S A NO A Q U I N Environmental Health Department <br /> ------COUNTY--------- <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: rAc I City: r-reKck Cq <br /> Well Location APN: j q.3. 33 <br /> Well Latitude: 0 -10 N Well Longitude: lU o IV, It.03�' <br /> Flood Plain Designation: �,J Well Elevation: <br /> Applicant Name: " w vv tet L o-t j a Applicant Title: ON.,,rl r <br /> Applicant Address: Z o b p 1 IFI City: L y �hColl <br /> Applicant Phone: y , $ Applicant email: <br /> Property Owner Name: <br /> Property Owner Address: City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED,WELL INFORMATION <br /> Well Total Depth(ft): d ' Acres to be Served by Well: 2 <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): <br /> Proposed Well Capacity(gal/ft): $po Estimated Pumping Rate(gal/min): eVpp <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): 2 rf.�, <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: ElDomestic 11Irrigation EJSmall Public Water Supply ElMunicipal Public Water Supply ElIndustrial ❑ 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): To: From: <br /> Annual Extraction Volume(acre-feet: ❑ 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 />