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S A Nj U AQ U I N Environmental Health Department <br /> COUNTY--- - <br /> ` xr,c,�,� Greatness grows (fere. <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: f'C Z-7, �'� City: S iz�c �-t-p„; <br /> Well Location APN: ) <br /> Well Latitude: 3 v 9/ k Well Longitude: _ l,�_I , / q rl } <br /> Flood Plain Designation:1 Well Elevation: �� s ��, <br /> Applicant Name: lRvo,-r�- %s `ft� S stY� Applicant Title: Com.- S« <br /> Applicant Address: ­-21,20W; c' / City: <br /> Applicant Phone: a„ 9_ 5.7-)- Y�2 Iu Applicant email: <br /> G-w ivt, <br /> Property Owner Name: <br /> Property Owner Address: 3 ( �cz? City: <br /> Property Owner Phone: aU 0 3 6,a Property Owner email: <br /> ~ PROPOSED WELL INFdFtMA'TION <br /> Well Total Depth(ft):1 Acres to be Served by Well: <br /> Use of Well: ❑ Domestic W.Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): Jar e <br /> Proposed Well Capacity(gal/ft): 6S-p k Estimated Pumping Rate(gal/min): 6S-0 <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): f7 — <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: Ib Domestic ❑ Irrigation ❑Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑Stock <br /> ❑Other: <br /> Total Depth(ft): �-uo To: From: <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): �ZS- To: From: <br /> nnual Extraction Volume(acre-feet: YZ} 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 />