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SAN J Od H I N Edronmental Health Department <br /> -- -C O U i-,l T Y------ <br /> Gi_o tr -.s:; <br /> New Well Information . <br /> e_f ron Pursuant to California Water Code, Section 13808, all new wells that do not meet the exem <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: .L,5 ' a� City: L <br /> Well Location APN: <br /> Well Latitude:3 Y--0` 13/ Well Longitude: /1-1-0 . f V e2 <br /> Flood Plain Designation: Well Elevation: / �, ' <br /> Applicant Name: cI k ," Applicant Title: <br /> Applicant Address: joy, . �, cv��c ;�" t City: <br /> Applicant Phone: 9,,9 g-3 j y- c/-7_4,5- Applicant email: <br /> Property Owner Name: 0(j t 0e, SL C . <br /> Property Owner Address: 9- fo &!� s City: (yup <br /> Property Owner Phone: 9- _ )SX,)— Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Q Q�tt Well Total Depth(ft):j I Wee Acres to be Served by Well: <br /> v <br /> El Domestic 121rigation 13 Small Public Water Supply ❑ Municipal Public Water Supply El Industrial El Stock <br /> Use of Well: <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): ti <br /> Proposed Well Capacity(gal/ft): fL vN Estimated Pumping Rate(gal/min): <br /> Anticipated Pumping Schedule(gal/day): t o1'I Estimated Annual Extraction Volume(acre-feet): <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): —7( -3 <br /> EXISTING WELLS INFORMATION <br /> Total Number of Existing Wells on Property: = <br /> Plea"se 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): '5'00 To: From: <br /> Casing Diameter(in): 11 ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 10 LkM j4,,,"^ To: From: <br /> Annual Extraction Volume(acre-feet: A--C ` ly Estimated ❑ Measured <br /> Specific Capacity(gal/min/ft): µ :. <br /> Other Pumping Tests Performed: -ov..` Test Result: <br /> 1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />