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Y <br /> SAN i 4011 N Environmental Health epartment <br /> --C•U N T Y------- <br /> f.7'"2Cifi'�urS i!rov.S 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 /> "-1 Ev5 \\, <br /> WELL LOCATION AN4 OWNER INFORMATION <br /> Well Location Address: J City: t" <br /> Well Location APN: L{po <br /> Well Latitude: 3Y, Well Longitude: -010, 9(1911-1 <br /> Flood Plain Designation: Well Elevation: / C Y <br /> Applicant Name: k,( k,�,� �� Applicant Title: <br /> Applicant Address: WHO 6r• City: G(; <br /> Applicant Phone: d,,6-33 _ Applicant email: <br /> Property Owner Name: r4,9en 0ti KS U <br /> Property Owner Address: !� o r r ftt City: 64 C t- 9 _6 <br /> Property Owner Phone: 9 9P _ Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft):1 I We Acres to be Served by Well: <br /> Use of Well: ❑ Domestic E-Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): 4jj <br /> Proposed Well Capacity(gal/ft): Estimated Pumping Rate(gal/min): bio <br /> Anticipated Pumping Schedule(gal/day): 1 it A, vyEstimated Annual Extraction Volume(acre-feet): 10L <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): 2�l <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: <br /> ❑ Domestic [?Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Total Depth(ft) 500 To: From: <br /> Casing Diameter(in): ❑Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): goo /o tAY)K,e,n To: From: <br /> X Annual Extraction Volume(acre-feet: ids >K Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): 64,.7 <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 />