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SAN J O A Q U I N Environmental Health Department <br /> -----COUNTY <br /> Crr-ntness 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: � 44-55;- LX) City: <br /> Well Location APN: 0 <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: �'6' nl1voln�2 .— Applicant Title: <br /> Applicant Address: jl0 �C City: <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: r— A �p <br /> Property Owner Address: SO f GS City: <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I f1w _ Acres to be Served by Well:1 3, <br /> Use of Well: #Domestic girrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): p <br /> Anticipated Pumping Schedule(gal/day): j;240 Estimated Annual Extraction Volume(acre-feet): <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 S <br /> Use of Well110 <br /> Domestic ❑ Irrigation ❑Small Public Water Supply El Municipal Public Water Supply El Industrial El Stock <br /> Other: <br /> Total Depth(ft): 3e$r To: From: <br /> Casing Diameter(in): 6' ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): $ To: From: <br /> Annual Extraction Volume(acre-feet: 2 0 Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): $'Q <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 />