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1 J <br /> .10A 0 U I N Environmental Health Df partni�-,. nt <br /> C c`,IJ f'\i T 1' <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: J_S — Ld --T-city-.1 ( ! �� <br /> Well Location APN:©V _;L,3 U �u I <br /> Well Latitude: 3 ,0 Well Longitude: <br /> Flood Plain Designation: Well Elevation: C�1 <br /> Applicant Name: ! ���S Applicant Title: ' ,'jle. <br /> Applicant Address: X -7 fj. „z City: 4vw,f bl,C - <br /> Applicant Phone:AO 7,9-5- Applicant email: <br /> Property Owner Name: L oea <br /> Property Owner Address: c1r e,; p;j- to( City: <br /> Property Owner Phone: J- 3 S,Z,�-_ Nets-,- Property Owner email: <br /> PROPOSED WELL INFORMATION <br /> Well Total Depth(ft): 15190 Acres to be Served by Well: <br /> Use of Well: ❑ Domestic ©'Irrigation ❑ Small Public Water Supply ❑ Municipal Public Water Supply ❑ Industrial ❑ Stock <br /> ❑ Other: <br /> Depth of Corcoran Clay(ft): <br /> Proposed Well Capacity(gal/ft): ?-Z-X--� Estimated Pumping Rate(gal/min): X400 <br /> Anticipated Pumping Schedule(gal/day): OaO Estimated Annual Extraction Volume(acre-feet): %Q A? <br /> Estimated Cumulative Extraction Volume before January 1,2020(acre-feet): 71 If <br /> EXISTING WELLS INFORMATION <br /> Total,Number of Existing Wells on Property: S� <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): 61 To: From: <br /> Casing Diameter(in): ❑ Open Bottom or Screen Interval(ft): To: From: <br /> Pumping Rate(gpm): 14 pi To: From: <br /> Annual Extraction Volume(acre-feet:Job J4 Estimated ❑ Measured <br /> Specific Capacity(gal/minlft): Un <br /> Other Pumping Tests Performed: yj,J,n &_ I 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 />