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SAN J O A Q U I N Environmental Health Department <br /> COUNTY - - <br /> (7 -otness grows hcr• . <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: _ — City: ( ! i?, <br /> Well Location APN:0 v _)L,-3 <br /> Well Latitude: Well Longitude: ._j.,v, f 7.� <br /> Flood Plain Designation: Well Elevation: / 7 -/ <br /> Applicant Name: (� v���,S Applicant Title: <br /> Applicant Address: PCJx 1,Ute,, z City: <br /> Applicant Phone:}�— ,/ 7 Applicant email: <br /> Property Owner Name: D(61 600e- <br /> Property <br /> 0 i e^Property Owner Address: f);r ��-� City: Gam./,L <br /> Property Owner Phone: — 3S_),)_- A(e Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth (ft): 1SE��� Acres to be Served by Well: <br /> Use of Well: ❑ Domestic PIrrigation ❑ 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): _—I&O <br /> Anticipated Pumping Schedule(gal/day): Estimated Annual Extraction Volume(acre-feet): 16 k• <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): "? 1 <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: ❑ Domestic rrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ 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): U ,, , j4 il To: From: <br /> Annual Extraction Volume(acre-feet: P Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): t4,i <br /> Other Pumping Tests Performed: n,jr 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 />