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SAN _ J O A Q U I N Environmental Health Department <br /> ---COUNTY - - <br /> n{" Greatness grows h,r, <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: k1j. S,_Q1rVV)t P17- I City: Lod,, <br /> Well Location APN: �Cj GJ <br /> Well Latitude: Well Longitude: <br /> Flood Plain Designation: Well Elevation: <br /> Applicant Name: ,, �t �h Applicant Title: <br /> Applicant Address; rj , fgo/, Aa L City: <br /> Applicant Phone: _ �2 7 7 Applicant email:I\1q' 2 6W,n Q Sbc ►o ba\ .he4 <br /> Property Owner Name: \,\ "C <br /> Property Owner Address: 5 I 1 W- t rA- v� D• <br /> Property Owner Phone: Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): Acres to be Served by Well: li a 3 <br /> Use of Well: ❑ Domestic Li Irrigation 1:1 Small Public Water Supply ❑ Municipal Public Water Supply Industrial E] Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): C1 Estimated Pumping Rate(gal/min): 'aa P/'1 <br /> Anticipated Pumping Schedule(gal/day): 6 ,fes\jell Estimated Annual Extraction Volume(acre-feet): 0 oZ <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: i <br /> Please complete the information below for every well on property. Use extra paper if needed <br /> Well#1 Information <br /> Use of Well: A Domestic ❑ Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft): X75 To: 0115 From: 075 <br /> Casing Diameter(in): (p •❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 'rj To: From: <br /> Annual Extraction Volume(acre-feet: .()-7(o )K Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft)] <br /> Other Pumping Tests Performed: ITest 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 />