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SANAOAQUIN p <br /> a <br /> Environmental Health Department <br /> " LlF' ;-' COUNTY <br /> Greotness 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 INF MATION <br /> Well Location Address: \ %jon�NCity: <br /> Well Location APN: 65 a.?Olc9 <br /> Well Latitude: N-� Well Longitude: kms/ <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: ,_� Applicant Title: r rn <br /> Applicant Address: -SC54n 5, y O Cit . <br /> ,r� o L <br /> Applicant Phone: Applicant email: <br /> Property Owner Name: UQ v 1,65 <br /> QNB <br /> Property Owner Address: a (, City: S c✓— <br /> Property Owner Phone: _ Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): I S 8-00 Acres to be Served by Well: L(' <br /> Use of Well: ❑ Domestic �K 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): Estimated Pumping Rate(gal/min): DIZIA <br /> Anticipated Pumping Schedule(gal/day): 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 <br /> Use of WelE- EO] <br /> Domestic ❑ Irrigation ❑ Small Public Water Supply ElMunicipal Public Water Supply ❑ Industrial ❑ Stock <br /> Other: <br /> Total Depth(ft): To: From: <br /> Casing Diameter(in): l ❑ 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: I Test Result: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.ccm <br />